Accuracy of various subthalamic nucleus targeting methods and an appropriated formula for Thai patients.
OBJECTIVE
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has recently been the standard surgical treatment for Parkinson's disease. Besides appropriate selection of patients, precise STN targeting is the most crucial factor for good surgical outcomes. However, there is no single targeting method universally accepted as the most accurate technique. Thus, the authors studied the accuracy of various STN targeting methods and proposed a formula for Thai patients.


METHODS
Sixteen patients with Parkinson's disease who fulfilled the intraoperative criteria of good STN targeting and had significant clinical improvements, without any stimulation-induced adverse effects, were included in the present study. Positions of the STN were determined by four targeting methods, direct targeting by axial T2W MRI, direct targeting by coronal T2W MRI, indirect targeting by anterior commissure-posterior commissure based formula and indirect targeting by adjustable digital Schaltenbrand-Wahren (SW) atlas, were compared with the final lead positions. The final lead positions by the four targeting methods were averaged to get an appropriate AC-PC based formula for Thai patients.


RESULTS
The most accurate STN targeting method was axial T2W MRL followed by coronal T2W MRI, AC-PC based formula and the SW atlas, respectively. The averaged final lead positions obtained from the four methods was X = 11.5 +/- 1.0, Y = -3.3 +/- 1.0 and Z = -4.8 +/- 0.42 mm.


CONCLUSIONS
The direct targeting by axial T2W MRI yielded the highest accuracy and the appropriate STN formula for Thai patients appeared to be X = +/- 11.5, Y = -3.5 (-3.3) and Z = -5.0 (-4.8) mm.
Nunta-aree
Sarun
S
Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. sisna@mahidol.ac.th
Tuntongtip
Dilok
D
Sitthinamsuwan
Bunpot
B
Srirabheebhat
Prajak
P
Nitising
Akkapong
A
Witthiwej
Teerapol
T
D044466:Asian People; D001931:Brain Mapping / Q000379:methods; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D010300:Parkinson Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012012:Red Nucleus / Q000473:pathology; D012189:Retrospective Studies; D013238:Stereotaxic Techniques / Q000592:standards*; D020531:Subthalamic Nucleus / Q000033:anatomy & histology / Q000503:physiopathology*; D013785:Thailand; D014057:Tomography, X-Ray Computed