title: Evaluating indirect subthalamic nucleus targeting with validated 3-tesla magnetic resonance imaging.
abstract: OBJECTIVE
  Indirect targeting of the subthalamic nucleus (STN) is commonly utilized at deep brain stimulation (DBS) centers around the world. The superiority of either midcommissural point (MCP)-based or red nucleus (RN)-based indirect targeting remains to be established.
  
  
  METHODS
  The location of the STN was determined and statistically compared to MCP- and RN-based predictions in 58 STN DBS patients, using a validated 3-tesla MRI protocol. The influence of additional neuroanatomical parameters on STN midpoint location was evaluated. Linear regression analysis was utilized to produce an optimized MCP/RN targeting model. Targeting coordinates at 1.5 T were compared to results at 3 T.
  
  
  RESULTS
  Accuracy and precision for RN-based targeting was superior to MCP-based targeting to predict STN midpoint location for each coordinate dimension (p < 0.01 and p < 0.05, respectively). RN-based targeting was statistically equivalent to an optimized regression-based targeting strategy incorporating multiple neuroanatomical parameters, including third-ventricle width and overall brain size. RN-based targeting at 1.5 T yielded equivalent coordinates to targeting at 3 T.
  
  
  CONCLUSIONS
  RN-based targeting is statistically superior to MCP-based STN targeting and accommodates broad variations in neuroanatomical parameters. Neurosurgeons utilizing indirect targeting of the STN may consider favoring RN-based over MCP-based indirect targeting methods.
authors.affiliation: Surgical Therapies Improving Movement Program, University of Michigan, Ann Arbor, Mich., USA.
authors.forename: Layla
authors.initials: L
authors.lastname: Houshmand
authors.forename: Karen S
authors.initials: KS
authors.lastname: Cummings
authors.forename: Kelvin L
authors.initials: KL
authors.lastname: Chou
authors.forename: Parag G
authors.initials: PG
authors.lastname: Patil
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation; D006801:Humans; D058542:Implantable Neurostimulators; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D010300:Parkinson Disease / Q000473:pathology / Q000601:surgery; D012012:Red Nucleus / Q000473:pathology / Q000601:surgery*; D020531:Subthalamic Nucleus / Q000473:pathology / Q000601:surgery*