title: Targeting of the Subthalamic Nucleus for Deep Brain Stimulation: A Survey Among Parkinson Disease Specialists.
abstract: BACKGROUND
  Deep brain stimulation within or adjacent to the subthalamic nucleus (STN) represents the most common stereotactic procedure performed for Parkinson disease. Better STN imaging is often regarded as a requirement for improving stereotactic targeting. However, it is unclear whether there is consensus about the optimal target.
  
  
  METHODS
  To obtain an expert opinion on the site regarded optimal for "STN stimulation," movement disorder specialists were asked to indicate their preferred position for an active contact on hard copies of the Schaltenbrand and Wahren atlas depicting the STN in all 3 planes. This represented an idealized setting, and it mimicked optimal imaging for direct target definition in a perfectly delineated STN.
  
  
  RESULTS
  The suggested targets were heterogeneous, although some clustering was observed in the dorsolateral STN and subthalamic area. In particular, in the anteroposterior direction, the intended targets differed to a great extent. Most of the indicated targets are thought to also result in concomitant stimulation of structures adjacent to the STN, including the zona incerta, fields of Forel, and internal capsule.
  
  
  CONCLUSIONS
  This survey illustrates that most sites regarded as optimal for STN stimulation are close to each other, but there appears to be no uniform perception of the optimal anatomic target, possibly influencing surgical results. The anatomic sweet zone for STN stimulation needs further specification, as this information is likely to make magnetic resonance imaging-based target definition less variable when applied to individual patients.
authors.affiliation: Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany. Electronic address: w.hamel@uke.de.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hamel
authors.affiliation: Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Köppen
authors.affiliation: Neurosurgical Department, Medical University of Vienna, Vienna, Austria.
authors.forename: François
authors.initials: F
authors.lastname: Alesch
authors.affiliation: Parkinson's Disease and Movement Disorders Unit, IRCCS San Camillo Hospital, Venice, Italy; First Neurology Clinic, University Hospital of Padua, Padua, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Antonini
authors.affiliation: Department of Neurosurgery, Institute of Neurosciences, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Barcia
authors.affiliation: Department of Medical Neurobiology, Institute for Medical Research, Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel; The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel.
authors.forename: Hagai
authors.initials: H
authors.lastname: Bergman
authors.affiliation: Grenoble Institute of Neurosciences, INSERM U836, Joseph Fourier University, Grenoble, France; Department of Neurosurgery, Grenoble University Hospital, Grenoble, France.
authors.forename: Stephan
authors.initials: S
authors.lastname: Chabardes
authors.affiliation: Department of Neurology, Haga Teaching Hospital, Den Haag, The Netherlands; Department of Neurosurgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Maria Fiorella
authors.initials: MF
authors.lastname: Contarino
authors.affiliation: Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Cornu
authors.affiliation: Klinikum Fürstenfeldbruck, Fürstenfeldbruck, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: Demmel
authors.affiliation: Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: Günther
authors.initials: G
authors.lastname: Deuschl
authors.affiliation: Morton and Gloria Shulman Movement Disorders Clinic and Edmond J. Safra Program in Parkinson's Disease, Movement Disorder Centre, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fasano
authors.affiliation: Department of Neurology, Charité, Campus Virchow Klinikum, University Medicine Berlin, Berlin, Germany.
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Kühn
authors.affiliation: Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom.
authors.forename: Patricia
authors.initials: P
authors.lastname: Limousin
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Cameron C
authors.initials: CC
authors.lastname: McIntyre
authors.affiliation: Department of Neurosurgery, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: H Maximilian
authors.initials: HM
authors.lastname: Mehdorn
authors.affiliation: Service of Neurology, Casa di Cura Villa Margherita, Arcugnano, Vicenza, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Pilleri
authors.affiliation: Department of Neurology, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Pollak
authors.affiliation: Neurology, University Hospital Donostia, San Sebastian, Spain; Neuroscience Unit, BioDonostia Research Institute, Basque Center on Cognition, Brain and Language, San Sebastian, Spain; Ikerbasque, Basque Foundation for Science, Bilbao, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodríguez-Oroz
authors.affiliation: Department of Neurosurgery, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rumià
authors.affiliation: Department of Neurology, National Parkinson Foundation Centre of Excellence, King's College Hospital, King's Health Partners, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Samuel
authors.affiliation: Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Köln, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Timmermann
authors.affiliation: Movement Disorders Unit, Institut de Neurosciènces, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Valldeoriola
authors.affiliation: Department of Functional and Stereotactic Neurosurgery, University Clinic, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Vesper
authors.affiliation: Department of Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany.
authors.forename: Veerle
authors.initials: V
authors.lastname: Visser-Vandewalle
authors.affiliation: Department of Neurology, University Clinic of Würzburg, Würzburg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Volkmann
authors.affiliation: Division of Neurology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Andres M
authors.initials: AM
authors.lastname: Lozano
mesh_terms: D001291:Attitude of Health Personnel; D046690:Deep Brain Stimulation / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D038622:Internationality; D008297:Male; D000072141:Neurologists / Q000706:statistics & numerical data*; D010300:Parkinson Disease / Q000453:epidemiology* / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D020531:Subthalamic Nucleus
keywords: Deep brain stimulation; Parkinson disease; Subthalamic nucleus; Targeting