title: Skewering the subthalamic nucleus via a parietal approach.
abstract: OBJECTIVE
  A frontal burr hole around the level of the coronal suture is the conventional entry point when performing subthalamic nucleus (STN) deep brain stimulation (DBS). However, alternative approaches may sometimes be necessary.
  
  
  METHODS
  We present a report of delayed hardware erosion through the scalp in the left frontal region after successful bilateral STN DBS for Parkinson's disease. The left STN was retargeted via a parietal entry point.
  
  
  RESULTS
  Significant improvement in UPDRS motor score (59%) was obtained with bilateral stimulation 6 months after re-operation. The literature was examined for similar approaches and the rationale, risks and benefits of non-frontal entry points in functional neurosurgery were explored.
  
  
  CONCLUSIONS
  Together with a brief review of STN anatomy, this report demonstrates that the parietal approach to the STN remains a viable option in addition to the more traditional frontal access.
authors.affiliation: Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, London, UK. l.zrinzo@ion.ucl.ac.uk
authors.forename: Ludvic
authors.initials: L
authors.lastname: Zrinzo
authors.forename: Etienne M
authors.initials: EM
authors.lastname: Holl
authors.forename: Erika A
authors.initials: EA
authors.lastname: Petersen
authors.forename: Patricia
authors.initials: P
authors.lastname: Limousin
authors.forename: Thomas
authors.initials: T
authors.lastname: Foltynie
authors.forename: Marwan I
authors.initials: MI
authors.lastname: Hariz
mesh_terms: D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010294:Parietal Bone / Q000601:surgery*; D010300:Parkinson Disease / Q000628:therapy*; D012307:Risk Factors; D020531:Subthalamic Nucleus / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome