Surgical Therapies Improving Movement Program, University of Michigan Health System, Ann Arbor, Michigan 48109-5338, USA.
Neurosurgery. 2012 Dec;71(6):1089-95; discussion 1095. doi: 10.1227/NEU.0b013e318270611f.
Accurate localization of the subthalamic nucleus (STN) is critical to the success of deep brain stimulation surgery for Parkinson disease. Recent developments in high-field-strength magnetic resonance imaging (MRI) have made it possible to visualize the STN in greater detail. However, the relationship of the MR-visualized STN to the anatomic, electrophysiological, or atlas-predicted STN remains controversial.
To evaluate the size of the STN visualized on 3-T MRI compared with anatomic measurements in cadaver studies and to compare the predictions of 3-T MRI and those of the Schaltenbrand-Wahren (SW) atlas for intraoperative STN microelectrode recordings.
We evaluated the STN by 3-T MRI and intraoperative microelectrode recordings in 20 Parkinson disease patients undergoing deep brain stimulation surgery. We compared our findings with anatomic cadaver studies and with the individually scaled SW atlas-based predictions for each patient.
The dimensions of the 3-T MR-visualized STN were very similar to those of the largest anatomic study (MRI length, width, and height: 9.8 ± 1.6, 11.5 ± 1.6, and 3.7 ± 0.7 mm, respectively; n = 40; cadaver length, width, and height: 9.3 ± 0.7, 10.6 ± 0.9, and 3.1 ± 0.5 mm, respectively; n = 100). The amount of STN traversed during intraoperative microelectrode recordings was better correlated to the 3-T MR-visualized STN than the SW atlas-predicted STN (R = 0.38 vs R = -0.17).
The STN as visualized on 3-T MRI corresponds well with cadaveric anatomic studies and intraoperative electrophysiology. STN visualization with 3-T MRI may be an improvement over SW atlas-based localization for STN deep brain stimulation surgery in Parkinson disease.
准确的丘脑底核（STN）定位对于帕金森病的脑深部刺激手术的成功至关重要。高磁场强度磁共振成像（MRI）的最新发展使得更详细地可视化 STN 成为可能。然而，MR 可视化的 STN 与解剖学、电生理学或图谱预测的 STN 之间的关系仍存在争议。
评估 3-T MRI 上可视化的 STN 与尸体研究中的解剖学测量值的大小，并比较 3-T MRI 和 Schaltenbrand-Wahren（SW）图谱对术中 STN 微电极记录的预测。
我们在 20 名接受脑深部刺激手术的帕金森病患者中通过 3-T MRI 和术中微电极记录评估了 STN。我们将我们的发现与尸体解剖学研究以及每个患者的个体化 SW 图谱预测进行了比较。
3-T MR 可视化的 STN 的尺寸与最大的解剖学研究非常相似（MRI 长度、宽度和高度分别为 9.8 ± 1.6、11.5 ± 1.6 和 3.7 ± 0.7 mm，n = 40；尸体长度、宽度和高度分别为 9.3 ± 0.7、10.6 ± 0.9 和 3.1 ± 0.5 mm，n = 100）。术中微电极记录中穿过的 STN 数量与 3-T MR 可视化的 STN 相关性优于 SW 图谱预测的 STN（R = 0.38 与 R = -0.17）。
3-T MRI 上可视化的 STN 与尸体解剖学研究和术中电生理学相符。与基于 SW 图谱的 STN 定位相比，3-T MRI 上的 STN 可视化可能是帕金森病脑深部刺激手术的一种改进。
