Stereotactic Anatomy of the Human Subthalamic Nucleus: Providing Coordinates for Accurate Electrode Placement

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Abstract

Background and Study Aims

Stereotactic targeting of the subthalamic nucleus (STN) for insertion of deep brain stimulation (DBS) electrodes became popular in the last two decades. We present a study focused on the detailed stereotactic anatomy of the STN with respect to its targeting.

Material and Methods

We used cerebral magnetic resonance (MR) images from 26 patients (50 STNs) for the imaging study. The material of the anatomical study consisted of 24 cerebral hemispheres (24 STNs) from 16 normal human brains. We measured and analyzed the X, X′, Y, Y′, and Z, Z′ stereotactic coordinates of the STN at specific clinically important transverse, coronal, and sagittal planes.

Results

The STN extended almost 1.5 mm more lateral and almost 1 mm more posterior in patients < 60 years of age. The Y coordinate was more posterior and the X coordinate more lateral on MRI than in anatomical specimens. The left STN was located more lateral than the right STN. Analyzing our data we found a standard coronal zone 1.1 mm wide (zone T), a standard coronal plane (thus providing the most accurate Y target coordinate, plane M), and a standard transverse area (area C) for accurate right STN targeting.

Conclusions

Our study offers new insights into the stereotactic anatomy of the human STN. These data should be taken into account if performing STN DBS.

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