• Wolfgang Hamel, Johannes A Köppen, François Alesch, Angelo Antonini, Juan A Barcia, Hagai Bergman, Stephan Chabardes, Maria Fiorella Contarino, Philippe Cornu, Walter Demmel, Günther Deuschl, Alfonso Fasano, Andrea A Kühn, Patricia Limousin, Cameron C McIntyre, H Maximilian Mehdorn, Manuela Pilleri, Pierre Pollak, Maria C Rodríguez-Oroz, Jordi Rumià, Michael Samuel, Lars Timmermann, Francesc Valldeoriola, Jan Vesper, Veerle Visser-Vandewalle, Jens Volkmann, and Andres M Lozano.
• Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany. Electronic address: w.hamel@uke.de.
• World Neurosurg. 2017 Mar 1; 99: 41-46.

BackgroundDeep brain stimulation within or adjacent to the subthalamic nucleus (STN) represents the most common stereotactic procedure performed for Parkinson disease. Better STN imaging is often regarded as a requirement for improving stereotactic targeting. However, it is unclear whether there is consensus about the optimal target.MethodsTo obtain an expert opinion on the site regarded optimal for "STN stimulation," movement disorder specialists were asked to indicate their preferred position for an active contact on hard copies of the Schaltenbrand and Wahren atlas depicting the STN in all 3 planes. This represented an idealized setting, and it mimicked optimal imaging for direct target definition in a perfectly delineated STN.ResultsThe suggested targets were heterogeneous, although some clustering was observed in the dorsolateral STN and subthalamic area. In particular, in the anteroposterior direction, the intended targets differed to a great extent. Most of the indicated targets are thought to also result in concomitant stimulation of structures adjacent to the STN, including the zona incerta, fields of Forel, and internal capsule.ConclusionsThis survey illustrates that most sites regarded as optimal for STN stimulation are close to each other, but there appears to be no uniform perception of the optimal anatomic target, possibly influencing surgical results. The anatomic sweet zone for STN stimulation needs further specification, as this information is likely to make magnetic resonance imaging-based target definition less variable when applied to individual patients.Copyright © 2016 Elsevier Inc. All rights reserved.

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