Statistical analysis of 168 bilateral subthalamic nucleus implantations by means of the probabilistic functional atlas

OBJECTIVE: Statistical analysis of patients previously operated on may improve our methods of performing subsequent surgical procedures. In this article, we introduce a method for studying the functional properties of cerebral structures from electrophysiological and neuroimaging data by using the probabilistic functional atlas (PFA). The PFA provides a spatial distribution of the clinically most effective contacts normalized to a common space. This distribution is converted into a probability function for a given point in space to be inside an effective contact. The PFA was used to analyze spatial properties of the functional subthalamic nucleus (STN), defined as the spatial volume corresponding to the distribution of effective contacts. These results may potentially be useful in planning subthalamic implantation of electrodes. METHODS: In all, 168 bilateral subthalamic stimulations were examined. An algorithm was developed for converting these data into the PFA. The PFA for the STN (here called "atlas") was calculated with 0.25-mm3 resolution, and several features characterizing the left and right STN were studied. The analysis was performed with and without lateral compensation against the width of the third ventricle. The key feature introduced here used for analysis of the functional STN is a (probabilistic) functional volume of structure (defined for a given probability as the volume of a region whose every point has a probability equal to or greater than this given probability). RESULTS: The analysis has been performed for two situations: with and without lateral compensation against the width of the third ventricle. Without lateral compensation, the differences between the mean values and standard deviations of their barycenter coordinates for the left and right functional STNs are 0.31 and 0.18 mm, respectively. The left STN and right STN exhibit differences in functional volume size and probability distribution. The entire functional volume is 240 mm3 for the left and 229 mm3 for the right STN. A more prominent difference exists in the region of high probabilities (0.7 or higher), called "hot STN." The volume of the left hot STN is 5.52 mm3, whereas that of the right is 3.92 mm3. The left hot STN is 1.41 times bigger and 20% more dense than the right hot STN. For a given probability, the corresponding functional volume for the left hot STN is up to 43 times larger than that for the right STN. Practically speaking, lateral compensation does not ch