• Idit Tamir, Odeya Marmor-Levin, Renana Eitan, Hagai Bergman, and Zvi Israel.
• Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA; Department of Medical Neurobiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Department of Neurosurgery, Center for Functional and Restorative Neurosurgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel. Electronic address: iditt@hadassah.org.il.
• World Neurosurg. 2017 Oct 1; 106: 450-461.

ObjectiveThe clinical outcome of patients with Parkinson disease (PD) who undergo subthalamic nucleus (STN) deep brain stimulation (DBS) is, in part, determined by the length of the electrode trajectory through the motor STN domain, the dorsolateral oscillatory region (DLOR). Trajectory length has been found to correlate with the stimulation-related improvement in patients' motor function (estimated by part III of the United Parkinson's Disease Rating Scale [UPDRS]). Therefore, it seems that ideally trajectories should have maximal DLOR length.MethodsWe retrospectively studied the influence of various anatomic aspects of the brains of patients with PD and the geometry of trajectories planned on the length of the DLOR and STN recorded during DBS surgery. We examined 212 trajectories and 424 microelectrode recording tracks in 115 patients operated on in our center between 2010 and 2015.ResultsWe found a strong correlation between the length of the recorded DLOR and STN. Trajectories that were more lateral and/or posterior in orientation had a longer STN and DLOR pass, although the DLOR/STN fraction length remained constant. The STN target was more lateral when the third ventricle was wider, and the latter correlated with older age and male gender.ConclusionsTrajectory angles correlate with the recorded STN and DLOR lengths, and should be altered toward a more posterolateral angle in older patients and atrophied brains to compensate for the changes in STN location and geometry. These fine adjustments should yield a longer motor domain pass, thereby improving the patient's predicted outcome.Copyright © 2017 Elsevier Inc. All rights reserved.

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