title: Stimulation sites in the subthalamic nucleus projected onto a mean 3-D atlas of the thalamus and basal ganglia.
abstract: BACKGROUND
  In patients with severe forms of Parkinson's disease (PD), deep brain stimulation (DBS) commonly targets the subthalamic nucleus (STN). Recently, the mean 3-D Morel-Atlas of the basal ganglia and the thalamus was introduced. It combines information contained in histological data from ten post-mortem brains. We were interested whether the Morel-Atlas is applicable for the visualization of stimulation sites.
  
  
  METHODS
  In a consecutive PD patient series, we documented preoperative MRI planning, intraoperative target adjustment based on electrophysiological and neurological testing, and perioperative CT target reconstruction. The localization of the DBS electrodes and the optimal stimulation sites were projected onto the Morel-Atlas.
  
  
  RESULTS
  We included 20 patients (median age 62 years). The active contact had mean coordinates Xlat = ±12.1 mm, Yap = -1.8 mm, Zvert = -3.2 mm. There was a significant difference between the initially planned site and the coordinates of the postoperative active contact site (median 2.2 mm). The stimulation site was, on average, more anterior and more dorsal. The electrode contact used for optimal stimulation was found within the STN of the atlas in 38/40 (95 %) of implantations.
  
  
  CONCLUSIONS
  The cluster of stimulation sites in individual patients-as deduced from preoperative MR, intraoperative electrophysiology and neurological testing-showed a high degree of congruence with the atlas. The mean 3D Morel Atlas is thus a useful tool for postoperative target visualization. This represents the first clinical evaluation of the recently created atlas.
authors.affiliation: Klinik für Neurochirurgie, UniversitätsSpital Zürich, Frauenklinikstrasse 10, 8091, Zürich, Switzerland. Johannes.Sarnthein@usz.ch
authors.forename: Johannes
authors.initials: J
authors.lastname: Sarnthein
authors.forename: Dominik
authors.initials: D
authors.lastname: Péus
authors.forename: Heide
authors.initials: H
authors.lastname: Baumann-Vogel
authors.forename: Christian R
authors.initials: CR
authors.lastname: Baumann
authors.forename: Oguzkan
authors.initials: O
authors.lastname: Sürücü
mesh_terms: D000368:Aged; D001479:Basal Ganglia / Q000473:pathology / Q000503:physiopathology*; D001931:Brain Mapping; D046690:Deep Brain Stimulation / Q000379:methods; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000473:pathology / Q000628:therapy*; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000473:pathology / Q000503:physiopathology*; D013788:Thalamus / Q000473:pathology / Q000601:surgery*