The microanatomical environment of the subthalamic nucleus

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✓High-frequency stimulation of the subthalamic nucleus (STN) is a widely performed method to treat advanced Parkinson disease. Due to the limitations of current imaging techniques, the 3D microanatomy of the STN and its surrounding structures in the mesencephalon are not well known. Using images they obtained using a 9.4-tesla magnetic resonance (MR) imaging unit, the authors developed a 3D reconstruction of the STN and its immediate surroundings. During the postmortem investigation of a human brain, a sample of tissue in the area around the STN was isolated. This brain tissue was scanned in the three orthogonal planes at 1-mm slice thickness. The images generated were compared with photographs of conventionally stained brain tissue slices in different neuroanatomical books, and a 3D reconstruction was made. High-field MR imaging is an appropriate method for visualizing the microanatomy of the STN and its surroundings. The images allow an optimal analysis of the microenvironment of the STN in the three orthogonal planes and can be used for 3D reconstructions of this area with possible clinical applications in the future.

Abbreviations used in this paper:AC = anterior commissure; MR = magnetic resonance; PC = posterior commissure; SN = substantia nigra; STN = subthalamic nucleus.

Article Information

Address reprint requests to: Kim Rijkers, M.D., Department of Neurosurgery, Maastricht University Hospital, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. email: kimrijkers@gmail.com.

© AANS, except where prohibited by US copyright law.

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Figures

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    Three transverse slices. A: One of the most caudal slices at the level of the superior colliculus (SC) in which the STN is not yet visible. Prominently visible are the SN, adjoining upon the cerebral peduncle (CP) as a dark (hypointense) structure, and the red nucleus (RN). B: The most caudal part of the STN is visible, situated between the mediodorsal border of the SN and the lateral border of the red nucleus. C: The most cranial part of the SN has just disappeared caudally. The STN is now located immediately next to the cerebral peduncle, and has developed its characteristic almond shape. The red nucleus appears smaller compared to the previous slices. The thalamus (T) with its different nuclei is the most prominent structure. The retroflex fascicle is visible curving between the red nucleus and the periaqueductal gray matter (PAG). LGB = lateral geniculate body; MGB = medial geniculate body; ML = medial lemniscus; PT = pulvinar thalami; RF = retroflex fascicle; STT = spinothalamic tract.

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    Two coronal slices. Left: On the more rostral slice the STN is visible as an oval-shaped nucleus situated superior to the SN and lateral to the internal capsule (IC). Between the STN and thalamus the zona incerta is visible. Right: On the more caudal slice the SN has disappeared and the medial lemniscus and spinothalamic tract are prominently visible, as is the retroflex fascicle. The thalamus is the largest structure apparent. The nucleus located laterally in this slice is the lateral geniculate body. MT = mammillothalamic tract, ZI = zona incerta.

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    Sagittal slice in which the STN is clearly visible. It is again located adjacent to the SN with its granular appearance. The zona incerta is visible between the STN and the thalamus. The medial lemniscus and spinothalamic tract are prominently visible next to the cerebral peduncle.

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    A 3D reconstruction of the STN and surrounding structures based on high-field MR images. Structures are visible from a midsagittal viewpoint. This reconstruction emphasizes that the mammillary bodies and the PC are in one plane with the STN (bright orange area). Two other prominent structures are the SN (black area) and red nucleus (red area). MB = mammillary body.

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