Targeting the subthalamic nucleus.
The small size and surrounding neuronal structures and fibre tracts make the STN a difficult stereotactic target. In this article we present the technique used by us to target the STN. Our combined experience from two centres comprises 18 lesions and 27 stimulator implants in the STN. Our criteria for patient selection and the use of MRI, frame-on CT and volumetric image fusion are presented. The role of a movement disorder specialist neurologist in the operating theatre, local field potential recording, impedance monitoring, macrostimulation, post-operative CT/MRI and test stimulation are detailed.
Aziz
T Z
TZ
University Laboratory of Physiology, Department of Neurosurgery, Radcliffe Infirmary, Oxford, UK. tipuaziz@btinternet.com
Nandi
D
D
Parkin
S
S
Liu
X
X
Giladi
N
N
Bain
P
P
Gregory
R G
RG
Joint
C
C
Scott
R B
RB
Stein
J F
JF
D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D004564:Electrocoagulation / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D016343:Monitoring, Intraoperative; D010300:Parkinson Disease / Q000601:surgery / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000503:physiopathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome