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What is dorso-lateral in the subthalamic Nucleus (STN)?—a topographic and anatomical consideration on the ambiguous description of today’s primary target for deep brain stimulation (DBS) surgery

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Abstract

Introduction

The most frequently used target for DBS in advanced Parkinson Disease (PD) is the sensorimotor subthalamic nucleus (STN), anatomically referred to as dorso-lateral STN [3]. Ambiguities arise, regarding the true meaning of this description in the STN. Does “dorsal” indicate posterior or superior? At its best, this definition assigns two directions in space to a three-dimensional structure.

Objective

This paper evaluates the ambiguity and describes the sensorimotor part of the STN in stereotactic space.

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References

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Acknowledgements

The results of this work were presented at the Movement Disorders Conference 2007 in Istanbul, Turkey.

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Correspondence to Volker A. Coenen.

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Comments

Nucleus subthalamicus (STN) is at present the most frequently used target for deep brain stimulation (DBS) in cases of Parkinson disease. Therefore an understanding of the anatomy and function of this area is of great importance for the functional stereotaxy. The authors of this paper undertook the task and worked out the proper definition and nomenclature of this area in relation to the ACPC line and additionally the optimal target area with best functional effects within the STN. In the anatomical part of their work they collected the previously reported coordinates of the STN and compared them with the standard coordinates of the stereotactic atlas and with coordinates based on MRI performed from own cadaver studies. These anatomical data were compared with electrophysiological intraoperative recordings and stimulation effects obtained from 380 operated cases. The optimal target was found to be in the anterior lateral and superior part of the Nucleus subthalamicus.

This is a beautiful and very important basic work in functional stereotaxy of high scientific quality.

Peter Grunert

University of Mainz, Germany

The paper is excellent. It highlights an ambiguity of our anatomical nomenclature when describing the subthalamic nucleus (STN). The authors have highlighted this ambiguity and underscored the clinical relevance. They have proposed an appropriate anatomical description of the surgical target within the STN. The surgical success of this target is supported by an as yet unpublished study. Stereotactic neurosurgeons need to be able to communicate with one another in order to compare their surgical outcomes. This paper provides an anatomical vocabulary to define the surgical target within the STN.

Chris Honey

University of British, Columbia

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Coenen, V.A., Prescher, A., Schmidt, T. et al. What is dorso-lateral in the subthalamic Nucleus (STN)?—a topographic and anatomical consideration on the ambiguous description of today’s primary target for deep brain stimulation (DBS) surgery. Acta Neurochir (Wien) 150, 1163–1165 (2008). https://doi.org/10.1007/s00701-008-0136-x

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  • DOI: https://doi.org/10.1007/s00701-008-0136-x

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