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Kim Rijkers, Yasin Temel, Veerle Visser-Vandewalle, Linda Vanormelingen, Marjan Vandersteen, Peter Adriaensens, Jan Gelan, and Emile A. M. Beuls

Neuroanatomy New York , W.H. Freeman & Co , 1986 4 Schaltenbrand G , Wahren W : Atlas for Stereotaxy of the Human Brain Stuttgart , Georg Thieme , 1977 5 Talairach D , David M , Tournoux P : Atlas d'Anatomie Stereo-taxique. Reperage Radiologique Indirect des Noyaux Gris Centraux des Regions Mesencephalo-sous-optique et Hypothalamique de l'Homme Paris , Masson , 1957 6 Zonenshayn M , Rezai AR , Mogilner AY , Beric A , Sterio D , Kelly PJ : Comparison of anatomic and neurophysiological methods for subthalamic nucleus targeting

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Cole A. Giller, Evelyn E. Babcock, and Dianne B. Mendelsohn

. Conclusions The precise definition of the borders of the STN is not always possible when using MR images, and methods to locate the structure indirectly from more easily visible structures are useful. The angle seen between the descending IC and the SN on sagittal MR images allows such a localization of the STN, which can be used to refine its stereotactic location. References 1 Aziz TZ , Nandi D , Parkin S , Liu X , Giladi N , Bain P , et al : Targeting the subthalamic nucleus. Stereotact Funct Neurosurg 77

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Johannes C. Wöhrle, Christian Blahak, Hans-Holger Capelle, Wolfgang Fogel, Hansjoerg Bäzner, and Joachim K. Krauss

in our patient. Subthalamic nucleus stimulation alone reduced the parkinsonian features. But within 2 months after the operation, severe dystonia recurred and was not controlled by adjusted STN stimulation. Therefore, the initial control of dystonia could have been a temporary microlesion effect of the insertion of an electrode in the GPi. 6 Globus pallidus internus stimulation alone reduced the dystonia, but parkinsonian symptoms were less well controlled. The role of the STN as a possible target in treating dystonia remains unclear. The STN has been suggested as

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Kendall H. Lee, Su-Youne Chang, David W. Roberts, and Uhnoh Kim

neurotransmitter systems that may be activated by polysynaptic release of glutamate from the STN onto SNc neurons is the dopaminergic system. Acknowledgment We thank Dr. James C. Leiter, M.D., for his close reading and careful critique of this manuscript. References 1. Abosch A , Kapur S , Lang AE , et al : Stimulation of the subthalamic nucleus in Parkinson's disease does not produce striatal dopamine release. Neurosurgery 53 : 1095 – 1105 , 2003 Abosch A, Kapur S, Lang AE, et al: Stimulation of the subthalamic

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Alon Y. Mogilner, Djordje Sterio, Ali R. Rezai, Martin Zonenshayn, Patrick J. Kelly, and Aleksandar Beric

macro-stimulation. Subsequently, the pulse generators were implanted subcutaneously in the infraclavicular region and connected to the DBS electrode with a standard extension lead. Data Analysis Subthalamic Nucleus For ethical reasons, the duration of the recording sessions was kept as short as possible during the surgery. Single-cell activity was recorded on digital videotape. Analysis was performed postsurgery by using commercially available software. Each recording trajectory was evaluated for the following: average firing rate, cell density, number

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Ellen J. L. Brunenberg, Bram Platel, Paul A. M. Hofman, Bart M. ter Haar Romeny, and Veerle Visser-Vandewalle

targeting. The criteria that we used are briefly outlined below. Search Strategy First, we searched PubMed and ScienceDirect for papers published between January 1999 and January 2011, using the terms “targeting,” “magnetic resonance imaging,” “MRI,” or “visualization” in combination with “subthalamic nucleus” or “STN.” Second, we explored the bibliographies of relevant publications until no further additional studies were found. Papers were selected if they provided qualitative descriptions or quantitative results of direct or indirect MR imaging–based STN

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J. Richard Toleikis, Leo Verhagen Metman, Julie G. Pilitsis, Andrei Barborica, Sandra C. Toleikis, and Roy A. E. Bakay

, as shown in Fig. 2 . Subthalamic nucleus single-unit data acquired before, during, and after DBS electrode activation at each stimulation frequency (Toleikis JR, Toleikis SC, Barborica A, Verhagen L, Sturaitis MK, Bakay RA: Analysis of human single unit activity acquired during deep brain stimulation. Abstract presented at the 75th Annual Meeting of the American Association of Neurological Surgeons, Washington, DC, April 18, 2007) were sorted using an autoclustering method as implemented in the KlustaKwik 26 component of the MClust 3.5 toolbox ( http

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Arjun S. Chandran, Michael Bynevelt, and Christopher R. P. Lind

F uture progress to refine targets for deep brain stimulation (DBS) is critically dependent on precise placement and verification of electrodes in the brain. No stereotactic target is of more clinical importance or more nuanced regarding its imaging than the subthalamic nucleus (STN). The STN is difficult to image because of its biconvex shape, small size, oblique spatial orientation in 3 planes, and its close proximity to the substantia nigra (SN). 3 A high level of accuracy is required as the motor region of the STN is posterolateral, and unwanted

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Joshua M. Rosenow, Howard Tarkin, Elias Zias, Carmine Sorbera, and Alon Mogilner

interference in implantable cardioverter defibrillators. Pacing Clin Electrophysiol 24 : 465 – 468 , 2001 Kolb C, Zrenner B, Schmitt C: Incidence of electromagnetic interference in implantable cardioverter defibrillators. Pacing Clin Electrophysiol 24: 465–468, 2001 12. Kumar R , Lozano AM , Kim YJ , et al : Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson's disease. Neurology 51 : 850 – 855 , 1998 Kumar R, Lozano AM, Kim YJ, et al: Double-blind evaluation of

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Isabelle M. Germano, Jean-Michel Gracies, Donald J. Weisz, Winona Tse, William C. Koller, and C. Warren Olanow

): Neurosurgical Treatment of Movement Disorders. Park Ridge, IL: AANS Publication Committee, 1998, pp 169–175 7. Burchiel KJ , Anderson VC , Favre J , et al : Comparison of pallidal and subthalamic nucleus deep brain stimulation for advanced Parkinson's disease: results of a randomized, blinded pilot study. Neurosurgery 45 : 1375 – 1384 , 1999 Burchiel KJ, Anderson VC, Favre J, et al: Comparison of pallidal and subthalamic nucleus deep brain stimulation for advanced Parkinson's disease: results of a randomized, blinded pilot