Hasimoglu Ozan, Karaçoban Tuba Özge, Hanoglu Taha, Geylan Nur Bahar, Altinkaya Ayca, Erkan Buruc, Postalci Lütfi Şinasi, Tugcu Bekir
Neurosurgery Department, University of Health Sciences, Hamidiye Faculty of Medicine, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
Neurology Department, University of Health Sciences, Hamidiye Faculty of Medicine, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
CNS Neurosci Ther. 2025 Apr;31(4):e70307. doi: 10.1111/cns.70307.
This study examines how anatomical variations influence the targeting coordinates of the subthalamic nucleus (STN) in patients with Idiopathic Parkinson's Disease (IPD) undergoing Deep Brain Stimulation (DBS), with the goal of enhancing targeting accuracy.
A retrospective analysis was performed on 202 STNs from patients who received bilateral STN-DBS surgery. Pre- and postoperative imaging data were used to determine accurate STN coordinates, while brain volume measurements, ventricle size, Evans Index, and AC -PC length were analyzed. Atrophy grading scales were also applied. Correlation and regression analyses assessed the relationship between the STN target location and all anatomical parameters on the x, y, and z axes.
Age showed a significant positive correlation with lateral STN coordinate shift on the x-axis, with each additional year leading to a 0.046 mm shift. An increase in peripheral gray matter volume and a decrease in white matter volume were significantly associated with the lateral displacement of the STN. Total ventricle volume demonstrated a positive correlation with STN shift on both the x-axis (0.0227 mm per cm increase) and z-axis (0.0087 mm per cm increase). Significant correlations were also found for the Evans Index with lateral shift on the x-axis and for AC-PC length with vertical shifts.
Anatomical factors, such as brain volume, ventricle size, Evans Index, AC-PC length, and atrophy scores, significantly influence STN localization in PD patients undergoing DBS. Accounting for these shifts during surgical planning may improve electrode placement accuracy and enhance therapeutic outcomes, underscoring the importance of personalized targeting strategies.
本研究探讨解剖变异如何影响接受脑深部电刺激（DBS）的特发性帕金森病（IPD）患者丘脑底核（STN）的靶点坐标，以提高靶点定位的准确性。
对202例接受双侧STN-DBS手术患者的STN进行回顾性分析。术前和术后的影像数据用于确定STN的精确坐标，同时分析脑容量测量值、脑室大小、埃文斯指数和AC-PC长度。还应用了萎缩分级量表。相关性和回归分析评估了STN靶点位置与x、y和z轴上所有解剖参数之间的关系。
年龄与STN在x轴上的外侧坐标偏移呈显著正相关，每增加一岁导致0.046毫米的偏移。外周灰质体积增加和白质体积减少与STN的外侧移位显著相关。总脑室体积与STN在x轴（每增加1厘米增加0.0227毫米）和z轴（每增加1厘米增加0.0087毫米）上的移位均呈正相关。埃文斯指数与x轴上的外侧移位以及AC-PC长度与垂直移位之间也发现了显著相关性。
脑容量、脑室大小、埃文斯指数、AC-PC长度和萎缩评分等解剖因素显著影响接受DBS的帕金森病患者的STN定位。在手术规划过程中考虑这些移位可能会提高电极放置的准确性并改善治疗效果，强调了个性化靶向策略的重要性。
