Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
Chin Med J (Engl). 2009 Oct 20;122(20):2419-22.
Subthalamic deep brain stimulation (STN-DBS) has been shown to be effective in the treatment of Parkinson's disease. The site for permanent stimulation is still in debate. This study aimed to assess the position of active contacts in relation to the subthalamic nucleus.
We reviewed the location of 40 electrodes in 34 patients who underwent STN-DBS. The position of electrode was evaluated by postoperative magnetic resonance imaging (MRI). The position of active contacts was compared with the subthalamic nucleus (STN) determined by intraoperative electrophysiological mapping and postoperative MRI.
The average position of the 40 active contacts was (11.7 + or - 1.2) mm lateral, (0.6 + or - 1.3) mm anterior, and (0.7 + or - 1.4) mm vertical to the midcommissural point. The dorsal margin of the STN was (11.6 + or - 1.1) mm lateral, (0.2 + or - 1.1) mm anterior, and (1.3 + or - 1.1) mm vertical to the midcommissural point. When compared with the dorsal margin of the STN, the active contacts were located more dorsally (P = 0.033) and anteriorly (P = 0.012), no significant difference was found in the lateral direction (P = 0.107). When compared with the position of the STN, 26 (65%) of active contacts were located in the region dorsal to the STN, only 13 (32.5%) were located in the upper two-thirds portion of STN.
The site for permanent stimulation appears to be in the subthalamic region dorsal to the STN, close to the dorsal margin of the STN. Besides the dorsal portion of the STN, other structures such as fields of Forel H and zona incerta may also be involved in the therapeutic benefit of deep brain stimulation.
丘脑底核深部脑刺激（STN-DBS）已被证明对治疗帕金森病有效。永久性刺激的部位仍存在争议。本研究旨在评估活跃电极触点与丘脑底核的关系。
我们回顾了 34 名接受 STN-DBS 的患者的 40 个电极的位置。术后磁共振成像（MRI）评估电极位置。将活跃电极触点的位置与术中电生理图谱和术后 MRI 确定的丘脑底核（STN）进行比较。
40 个活跃触点的平均位置为（11.7±1.2）mm 外侧、（0.6±1.3）mm 前、（0.7±1.4）mm 垂直于中脑连合点。STN 的背侧边界为（11.6±1.1）mm 外侧、（0.2±1.1）mm 前、（1.3±1.1）mm 垂直于中脑连合点。与 STN 的背侧边界相比，活跃触点位于更背侧（P=0.033）和更前侧（P=0.012），但在外侧方向无显著差异（P=0.107）。与 STN 的位置相比，26 个（65%）活跃触点位于 STN 背侧区域，只有 13 个（32.5%）位于 STN 的上 2/3 部分。
永久性刺激部位似乎位于 STN 背侧的丘脑底核区域，靠近 STN 的背侧边界。除了 STN 的背侧部分，Forel H 区和未定带等其他结构也可能参与了深部脑刺激的治疗益处。
