A comparison between stereotactic targeting methods of the subthalamic nucleus in cases with Parkinson's disease

Several methods are used for targeting of the subthalamic nucleus (STN) for the surgical treatment of Parkinson's disease (PD). The goal of this study is to determine the most suitable morphological method for localizing the STN in order to perform deep brain stimulation (DBS) in the treatment of PD.

Twelve cases with PD underwent bilateral STN-DBS and followed up for 5 years. Indirect calculation of the STN using AC-PC coordinates, and direct targeting of the STN using stereotactic CT/MRI fusion, were used for targeting. A microelectrode recording method was used to localize the STN.

Direct targeting of the STN using CT/MRI fusion was very precise in every case, based upon evaluation of the intraoperative microelectrode recordings, postoperative MRI scans, and clinical follow-up of the cases. The coordinate differences obtained from these two methods were statistically significant.

Direct targeting method of the STN using CT/MRI fusion provided higher precision than the indirect calculation method. This method may be used as a standard targeting technique, and may obviate the need for using complicated technologies such as microelectrode recording, which may sometimes be risky and counterproductive.