Targeting of the Subthalamic Nucleus for Deep Brain Stimulation: A Survey Among Parkinson Disease Specialists
Targeting of the Subthalamic Nucleus for Deep Brain Stimulation: A Survey Among Parkinson Disease Specialists
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DOI：
10.1016/j.wneu.2016.11.012
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发表时间：
2017-03-01
影响因子：
2
通讯作者：
Lozano, Andres M.
中科院分区：
文献类型：
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作者：
Hamel, Wolfgang;Koeppen, Johannes A.;Lozano, Andres M.
背景：丘脑底核（STN）内或邻近的深部脑刺激是治疗帕金森病最常见的立体定向手术。更好的 STN 成像通常被认为是改善立体定向靶向的要求。然而，尚不清楚是否就最佳目标达成共识。 方法：为了获得有关“STN 刺激”最佳位置的专家意见，要求运动障碍专家在描绘所有 3 个平面中 STN 的 Schaltenbrand 和 Wahren 图集的硬拷贝上表明他们主动接触的首选位置。这代表了一种理想化的设置，并且它模仿了在完美描绘的 STN 中直接定义目标的最佳成像。结果：尽管在背外侧 STN 和丘脑底区域观察到一些聚集，但建议的目标是异质的。特别是在前后方向上，预期目标存在很大差异。大多数指定目标被认为也会导致 STN 附近结构的伴随刺激，包括未定带、Forel 区和内囊。结论：这项调查表明，大多数被认为最适合 STN 刺激的部位彼此靠近，但似乎对最佳解剖目标没有统一的认识，这可能会影响手术结果。 STN 刺激的解剖学最佳区需要进一步规范，因为该信息可能会使基于磁共振成像的目标定义在应用于个体患者时变化较小。
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 imaginge-based target definition less variable when applied to individual patients.