Wolfgang Hamel1, Johannes A Köppen2, François Alesch3, Angelo Antonini4, Juan A Barcia5, Hagai Bergman6, Stephan Chabardes7, Maria Fiorella Contarino8, Philippe Cornu9, Walter Demmel10, Günther Deuschl11, Alfonso Fasano12, Andrea A Kühn13, Patricia Limousin14, Cameron C McIntyre15, H Maximilian Mehdorn16, Manuela Pilleri17, Pierre Pollak18, Maria C Rodríguez-Oroz19, Jordi Rumià20, Michael Samuel21, Lars Timmermann22, Francesc Valldeoriola23, Jan Vesper24, Veerle Visser-Vandewalle25, Jens Volkmann26, Andres M Lozano27. 1. Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany. Electronic address: w.hamel@uke.de. 2. Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany. 3. Neurosurgical Department, Medical University of Vienna, Vienna, Austria. 4. Parkinson's Disease and Movement Disorders Unit, IRCCS San Camillo Hospital, Venice, Italy; First Neurology Clinic, University Hospital of Padua, Padua, Italy. 5. Department of Neurosurgery, Institute of Neurosciences, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain. 6. Department of Medical Neurobiology, Institute for Medical Research, Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel; The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel. 7. Grenoble Institute of Neurosciences, INSERM U836, Joseph Fourier University, Grenoble, France; Department of Neurosurgery, Grenoble University Hospital, Grenoble, France. 8. Department of Neurology, Haga Teaching Hospital, Den Haag, The Netherlands; Department of Neurosurgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands. 9. Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France. 10. Klinikum Fürstenfeldbruck, Fürstenfeldbruck, Germany. 11. Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany. 12. Morton and Gloria Shulman Movement Disorders Clinic and Edmond J. Safra Program in Parkinson's Disease, Movement Disorder Centre, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. 13. Department of Neurology, Charité, Campus Virchow Klinikum, University Medicine Berlin, Berlin, Germany. 14. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom. 15. Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA. 16. Department of Neurosurgery, University Hospital Schleswig-Holstein, Kiel, Germany. 17. Service of Neurology, Casa di Cura Villa Margherita, Arcugnano, Vicenza, Italy. 18. Department of Neurology, Geneva University Hospital, Geneva, Switzerland. 19. Neurology, University Hospital Donostia, San Sebastian, Spain; Neuroscience Unit, BioDonostia Research Institute, Basque Center on Cognition, Brain and Language, San Sebastian, Spain; Ikerbasque, Basque Foundation for Science, Bilbao, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain. 20. Department of Neurosurgery, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain. 21. Department of Neurology, National Parkinson Foundation Centre of Excellence, King's College Hospital, King's Health Partners, London, United Kingdom. 22. Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Köln, Germany. 23. Movement Disorders Unit, Institut de Neurosciènces, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain. 24. Department of Functional and Stereotactic Neurosurgery, University Clinic, Heinrich-Heine University, Düsseldorf, Germany. 25. Department of Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany. 26. Department of Neurology, University Clinic of Würzburg, Würzburg, Germany. 27. Division of Neurology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Deep brain stimulation within or adjacent to the subthalamic nucleus (STN) represents the most common stereotactic procedure performed for Parkinson disease. Better STN imaging is often regarded as a requirement for improving stereotactic targeting. However, it is unclear whether there is consensus about the optimal target. METHODS: To obtain an expert opinion on the site regarded optimal for "STN stimulation," movement disorder specialists were asked to indicate their preferred position for an active contact on hard copies of the Schaltenbrand and Wahren atlas depicting the STN in all 3 planes. This represented an idealized setting, and it mimicked optimal imaging for direct target definition in a perfectly delineated STN. RESULTS: The suggested targets were heterogeneous, although some clustering was observed in the dorsolateral STN and subthalamic area. In particular, in the anteroposterior direction, the intended targets differed to a great extent. Most of the indicated targets are thought to also result in concomitant stimulation of structures adjacent to the STN, including the zona incerta, fields of Forel, and internal capsule. CONCLUSIONS: This survey illustrates that most sites regarded as optimal for STN stimulation are close to each other, but there appears to be no uniform perception of the optimal anatomic target, possibly influencing surgical results. The anatomic sweet zone for STN stimulation needs further specification, as this information is likely to make magnetic resonance imaging-based target definition less variable when applied to individual patients.
BACKGROUND: Deep brain stimulation within or adjacent to the subthalamic nucleus (STN) represents the most common stereotactic procedure performed for Parkinson disease. Better STN imaging is often regarded as a requirement for improving stereotactic targeting. However, it is unclear whether there is consensus about the optimal target. METHODS: To obtain an expert opinion on the site regarded optimal for "STN stimulation," movement disorder specialists were asked to indicate their preferred position for an active contact on hard copies of the Schaltenbrand and Wahren atlas depicting the STN in all 3 planes. This represented an idealized setting, and it mimicked optimal imaging for direct target definition in a perfectly delineated STN. RESULTS: The suggested targets were heterogeneous, although some clustering was observed in the dorsolateral STN and subthalamic area. In particular, in the anteroposterior direction, the intended targets differed to a great extent. Most of the indicated targets are thought to also result in concomitant stimulation of structures adjacent to the STN, including the zona incerta, fields of Forel, and internal capsule. CONCLUSIONS: This survey illustrates that most sites regarded as optimal for STN stimulation are close to each other, but there appears to be no uniform perception of the optimal anatomic target, possibly influencing surgical results. The anatomic sweet zone for STN stimulation needs further specification, as this information is likely to make magnetic resonance imaging-based target definition less variable when applied to individual patients.
Authors: Bryan Howell; Faical Isbaine; Jon T Willie; Enrico Opri; Robert E Gross; Coralie De Hemptinne; Philip A Starr; Cameron C McIntyre; Svjetlana Miocinovic Journal: Brain Stimul Date: 2021-03-20 Impact factor: 8.955
Authors: Kenneth H Louie; Matthew N Petrucci; Logan L Grado; Chiahao Lu; Paul J Tuite; Andrew G Lamperski; Colum D MacKinnon; Scott E Cooper; Theoden I Netoff Journal: J Neuroeng Rehabil Date: 2021-05-21 Impact factor: 4.262
Authors: Maija Koivu; Antti Huotarinen; Filip Scheperjans; Aki Laakso; Riku Kivisaari; Eero Pekkonen Journal: Brain Behav Date: 2018-05-30 Impact factor: 2.708
Authors: Angela M Noecker; Anneke M Frankemolle-Gilbert; Bryan Howell; Mikkel V Petersen; Sinem Balta Beylergil; Aasef G Shaikh; Cameron C McIntyre Journal: Neuromodulation Date: 2021-01-03
Authors: Aristide Merola; Alberto Romagnolo; Vibhor Krishna; Srivatsan Pallavaram; Stephen Carcieri; Steven Goetz; George Mandybur; Andrew P Duker; Brian Dalm; John D Rolston; Alfonso Fasano; Leo Verhagen Journal: Neurol Ther Date: 2020-03-09