Neuroflow

Anatomy explorer

The targets behind the decision

A coordinate is not a biological target. Each structure below is presented with the anatomical, physiological and programming context that determines whether stimulation helps or harms.

STN

Subthalamic nucleus

Location

Biconvex nucleus in the subthalamic region, inferomedial to the internal capsule and dorsolateral to the red nucleus and substantia nigra.

Function

Glutamatergic node of the basal ganglia, receiving hyperdirect cortical input and driving pallidal output.

Clinical indication

Parkinson disease, particularly where reduction of dopaminergic medication is a therapeutic goal.

Trajectory considerations

  • Transfrontal trajectory avoiding sulci, ventricle and cortical vessels
  • Awareness of the internal capsule medially and anteriorly
  • Relationship of the dorsolateral motor territory to the planned entry

Neighbouring structures

  • Internal capsule
  • Substantia nigra
  • Red nucleus
  • Zona incerta
  • Medial lemniscus

Potential stimulation side effects

  • Capsular effects: tonic muscle contraction, dysarthria
  • Medial lemniscus: paraesthesia
  • Oculomotor fibres: gaze deviation, diplopia
  • Mood and impulse-control changes

Programming considerations

  • Dorsolateral contacts typically explored first in a structured monopolar review
  • Medication reduction planned alongside stimulation titration
  • Directional steering used to move the field away from capsule

Image placeholder

STN ANATOMY

Real clinical image required

Image typeSTN anatomy
DescriptionAxial and coronal atlas or high-field MRI showing STN boundaries with red nucleus and internal capsule labelled.
Clinical purposeDefines the target and its immediate hazards in the same image.
Suggested sourceTo be supplied — publication, institution or own series
Copyright statusNot yet cleared
CaptionTo be written with the final image
AssociationAnatomy Explorer · STN

Key references

  1. Follett KA, Weaver FM, Stern M, et al. Pallidal versus subthalamic deep-brain stimulation for Parkinson's disease. N Engl J Med. 2010;362(22):2077-2091.
  2. Odekerken VJJ, van Laar T, Staal MJ, et al. Subthalamic nucleus versus globus pallidus bilateral deep brain stimulation for advanced Parkinson's disease (NSTAPS study): a randomised controlled trial. Lancet Neurol. 2013;12(1):37-44.