title: Spatial distance between anatomically- and physiologically-identified targets in subthalamic nucleus deep brain stimulation in Parkinson's disease.
abstract: BACKGROUND
  Subthalamic nucleus (STN) stimulation is the treatment of choice for carefully chosen patients with idiopathic Parkinson's disease (PD) and refractory motor fluctuations. We evaluated the value of intraoperative electrophysiology during STN deep brain stimulation (DBS) procedures in refining the anatomically-defined target.
  
  
  METHODS
  We determined the spatial distance between the anatomical and physiological targets along x, y and z axes in 50 patients with PD who underwent bilateral subthalamic nucleus DBS surgery.
  
  
  RESULTS
  The mean spatial distance between anatomical and functional targets was 1.84 ± 0.88 mm and the least distances in different methods were 0.66 mm [standard error (SE): 0.07], 1.07 mm (SE: 0.08) and 1.01 mm (SE: 0.08) on x, y and z axes, respectively, for the combined method.
  
  
  CONCLUSIONS
  The most physiologically-accurate anatomical targeting was achieved via a combination of multiple independent methods. There was a statistically significant difference between the anatomical and functional targets in all methods (even the combined) on the y coordinate, emphasizing the need for intra-operative electrophysiological monitoring to refine the anatomico-radiologically-defined target.
authors.affiliation: Department of Neurosurgery, School of Medicine AND Rasoul-E-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mansour
authors.initials: M
authors.lastname: Parvaresh-Rizi
authors.affiliation: Department of Neurosurgery, School of Medicine AND Rasoul-E-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Tabibkhoei
authors.affiliation: Department of Neurosurgery, School of Medicine AND Rasoul-E-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Gholamali
authors.initials: G
authors.lastname: Shahidi
authors.affiliation: Neuromodulation, ‎Medtronic, Mumbai, India.
authors.forename: Janardan
authors.initials: J
authors.lastname: Vaidyanathan
authors.affiliation: Department of Neurosurgery, School of Medicine AND Rasoul-E-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Amirreza
authors.initials: A
authors.lastname: Tabibkhoei
authors.affiliation: Department of Neurosurgery, School of Medicine AND Rasoul-E-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Rohani
keywords: Anatomic Target; Deep Brain Stimulation; Intraoperative Monitoring; Parkinson's Disease; Physiologic Target