Table of Contents
ISRN Neurology
Volume 2012 (2012), Article ID 592678, 13 pages
http://dx.doi.org/10.5402/2012/592678
Clinical Study

Computed Three-Dimensional Atlas of Subthalamic Nucleus and Its Adjacent Structures for Deep Brain Stimulation in Parkinson's Disease

Department of Neurosurgery, Faculty of Medicine, Kinki University, 377-2 Ohno-higashi, Osaka-sayama, Osaka 589-8511, Japan

Received 17 August 2011; Accepted 25 September 2011

Academic Editor: A. K. Petridis

Copyright © 2012 Naoki Nakano et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is one of the standard surgical treatments for advanced Parkinson's disease. However, it has been difficult to accurately localize the stimulated contact area of the electrode in the subthalamic nucleus and its adjacent structures using a two-dimensional atlas. The goal of this study is to verify the real and detailed localization of stimulated contact of the DBS electrode therapeutically inserted into the STN and its adjacent structures using a novel computed three-dimensional atlas built by a personal computer. Method. A three-dimensional atlas of the STN and its adjacent structures (3D-Subthalamus atlas) was elaborated on the basis of sagittal slices from the Schaltenbrand and Wahren stereotactic atlas on a personal computer utilizing a commercial software. The electrode inserted into the STN and its adjacent structures was superimposed on our 3D-Subthalamus atlas based on intraoperative third ventriculography in 11 cases. Findings. Accurate localization of the DBS electrode was identified using the 3D-Subthalamus atlas, and its clinical efficacy of the electrode stimulation was investigated in all 11 cases. Conclusion. This study demonstrates that the 3D-Subthalamus atlas is a useful tool for understanding the morphology of deep brain structures and for the precise anatomical position findings of the stimulated contact of a DBS electrode. The clinical analysis using the 3D atlas supports the contention that the stimulation of structures adjacent to the STN, particularly the zona incerta or the field of Forel H, is as effective as the stimulation of the STN itself for the treatment of advanced Parkinson's disease.