Imaging of the subthalamic nucleus for deep brain stimulation: a systematic review

It is still debated which neuroimaging technique should be preferred in targeting the subthalamic nucleus (STN) for implantation of stimulating electrodes. In the present study, we systematically analyzed the different imaging techniques and their outcome in reports describing original data on bilateral STN stimulation in advanced Parkinson's disease. Five different imaging techniques to target the STN for implantation of stimulating electrodes were reported: magnetic resonance imaging (MRI), MRI in combination with ventriculography, MRI in combination with computed tomography (CT), CT, and CT in combination with ventriculography. We found that patients who underwent STN deep brain stimulation with MRI (regardless the use of an additional imaging technique) had a significantly better Unified Parkinson's Disease Rating Scale motor score (mean improvement 58%) as compared to patients who underwent STN deep brain stimulation with CT imaging (regardless the use of an additional imaging technique; mean improvement 47%).