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Vol. 89, No. 2, 2011
Issue release date: April 2011
Stereotact Funct Neurosurg 2011;89:70–75

Skewering the Subthalamic Nucleus via a Parietal Approach

Zrinzo L. · Holl E.M. · Petersen E.A. · Limousin P. · Foltynie T. · Hariz M.I.
Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, London, UK

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Background/Aims: A frontal burr hole around the level of the coronal suture is the conventional entry point when performing subthalamic nucleus (STN) deep brain stimulation (DBS). However, alternative approaches may sometimes be necessary. Methods: We present a report of delayed hardware erosion through the scalp in the left frontal region after successful bilateral STN DBS for Parkinson’s disease. The left STN was retargeted via a parietal entry point. Results: Significant improvement in UPDRS motor score (59%) was obtained with bilateral stimulation 6 months after re-operation. The literature was examined for similar approaches and the rationale, risks and benefits of non-frontal entry points in functional neurosurgery were explored. Conclusion: Together with a brief review of STN anatomy, this report demonstrates that the parietal approach to the STN remains a viable option in addition to the more traditional frontal access.

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