Computed Three-Dimensional Atlas of Subthalamic Nucleus and Its Adjacent Structures for Deep Brain Stimulation in Parkinson's Disease

Abstract

Background. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is one of the standard surgical treatments for advanced Parkinson's disease. However, it has been difficult to accurately localize the stimulated contact area of the electrode in the subthalamic nucleus and its adjacent structures using a two-dimensional atlas. The goal of this study is to verify the real and detailed localization of stimulated contact of the DBS electrode therapeutically inserted into the STN and its adjacent structures using a novel computed three-dimensional atlas built by a personal computer. Method. A three-dimensional atlas of the STN and its adjacent structures (3D-Subthalamus atlas) was elaborated on the basis of sagittal slices from the Schaltenbrand and Wahren stereotactic atlas on a personal computer utilizing a commercial software. The electrode inserted into the STN and its adjacent structures was superimposed on our 3D-Subthalamus atlas based on intraoperative third ventriculography in 11 cases. Findings. Accurate localization of the DBS electrode was identified using the 3D-Subthalamus atlas, and its clinical efficacy of the electrode stimulation was investigated in all 11 cases. Conclusion. This study demonstrates that the 3D-Subthalamus atlas is a useful tool for understanding the morphology of deep brain structures and for the precise anatomical position findings of the stimulated contact of a DBS electrode. The clinical analysis using the 3D atlas supports the contention that the stimulation of structures adjacent to the STN, particularly the zona incerta or the field of Forel H, is as effective as the stimulation of the STN itself for the treatment of advanced Parkinson's disease.

Coordinated reset stimulation in a large-scale model of the STN-GPe circuit

“…Additionally, the spatial structure enabled us to vary the electrode location within the stimulation target and thus we observed a strong relation between the electrode position and the stimulation outcome. This observation substantiates previous theoretical and experimental studies, which investigated the impact of the electrode position on the stimulation outcome for HF DBS (Voges et al, 2002 ; Paek et al, 2011 ; Guo et al, 2012 ; Nakano et al, 2012 ; Reese et al, 2012 ).…”

“…Furthermore, the required stimulation current amplitude was dependent on the electrode location. In the context of a clinically more effective electrode placement it is still under discussion, whether the optimal stimulation site for HF DBS lies within the interior of the STN or in fiber tracts located close to the STN (Voges et al, 2002 ; Paek et al, 2011 ; Guo et al, 2012 ; Nakano et al, 2012 ; Reese et al, 2012 ). In order to tackle this issue utilizing a modeling approach, a future version of our model should include spatially extended multi-compartment neurons instead of pointlike model neurons.…”

7T MRI subthalamic nucleus atlas for use with 3T MRI

“…A large proportion of human STN atlases currently in use was derived from ex vivo sections of a single brain. 11,31,32,[36][37][38][39][40][41] The utility of such histological atlases is limited by out-of-plane distortions, in-plane tears, and inconsistent staining. 42 Moreover, the utility of singlesubject atlases is limited by STN shape variability across individuals and age groups.…”

Microsurgical anatomy of the subthalamic nucleus: correlating fiber dissection results with 3-T magnetic resonance imaging using neuronavigation

“…The STN's intimate relationships with other elusive deep brain structures, such as the zona incerta (ZI), ansa lenticularis, medial forebrain bundle (MFB), medial lemniscus, and substantia nigra, further challenge precise targeting in STN-DBS lead implantation. 12,22,37,43,50,57,64 3D computer reconstruction of the STN has been shown to be effective for preoperative target identification before DBS surgery as well as for intraoperative recognition and postoperative assessment. 21,34,37,39,[65][66][67] Some fiber dissection studies have also been performed to describe STN anatomy.…”

“…12,22,37,43,50,57,64 3D computer reconstruction of the STN has been shown to be effective for preoperative target identification before DBS surgery as well as for intraoperative recognition and postoperative assessment. 21,34,37,39,[65][66][67] Some fiber dissection studies have also been performed to describe STN anatomy. 1,12,64 However, no study in the literature has combined 3D MRI reconstruction with generalized qsampling imaging (GQI) tractography and sectional anatomy of the STN through the fiber dissection technique.…”