Neuroanatomía Funcional del Núcleo Subtalámico: Revisión  exhaustiva sobre sus aplicaciones neuroquirúrgicas

Francisco Rivera; Nelson Ernesto Quintanal Cordero; Fabián Piedimonte

doi:10.47924/neurotarget2025482

Authors

Francisco Rivera CENIT Foundation for Neuroscience Research. Autonomous City of Buenos Aires. Argentina. https://orcid.org/0009-0005-8979-1906
Nelson Ernesto Quintanal Cordero CENIT Foundation for Neuroscience Research. Autonomous City of Buenos Aires. Argentina. https://orcid.org/0000-0003-3812-5899
Fabián Piedimonte CENIT Foundation for Neuroscience Research. Autonomous City of Buenos Aires. Argentina. https://orcid.org/0000-0003-4661-4449

DOI:

https://doi.org/10.47924/neurotarget2025482

Keywords:

subthalamic nucleus, functional neuroanatomy, deep brain stimulation, parkinson's disease, basal ganglia, stereotactic neurosurgery

Abstract

Background: The subthalamic nucleus (STN) represents a fundamental diencephalic structure within basal ganglia circuits and constitutes one of the primary therapeutic targets in neurosurgical treatment of movement disorders. Despite its clinical relevance, particularly as the most utilized surgical target for deep brain stimulation (DBS) in Parkinson's disease (PD), significant gaps persist in our understanding of human STN structural and functional organization.
Methods: Comprehensive literature review analyzing morphometric studies, connectivity patterns (cortical, subcortical, nigral, thalamic, and brainstem connections), cytoarchitectural organization, and functional subdivisions of the STN. Clinical implications for stereotactic neurosurgery are discussed.
Results: The STN is a lens-shaped structure with mean volume of 131.58-240 mm³ containing 239.500-561.000 neurons, showing age-related atrophy. The nucleus exhibits extensive connectivity with motor, associative, and limbic circuits through direct cortical projections (hyperdirect pathway) and reciprocal connections with the globus pallidus, substantia nigra, and thalamus. Functional tripartite organization includes: dorsolateral sensorimotor, ventromedial associative, and medial limbic regions. Intraoperative studies reveal mean discrepancies of 0.125 mm (X), 1.9 mm (Y), and 1.26 mm (Z) between anatomical imaging and definitive neurophysiological targets.
Discussion: The functional tripartite subdivision of the STN, supported by connectivity patterns, neuroimaging, and iron distribution studies, provides a neuroanatomical framework essential for understanding both motor and non-motor symptoms in movement disorders. The heterogeneous iron distribution correlates with functional subdivisions, with highest concentrations in medial-inferior limbic regions and lowest in posterolateral sensorimotor areas. Discrepancies between anatomical and neurophysiological targets highlight the dynamic functional nature of the STN, transcending purely geometric spatial characterization. Integration of anatomical precision with neurophysiological functionality represents a critical advancement in stereotactic surgical planning.
Conclusions: Comprehensive understanding of STN functional neuroanatomy is essential for optimal neurosurgical targeting in DBS procedures. The functional tripartite organization provides a framework for individualized surgical planning, while persistent anatomical-physiological target discrepancies underscore the critical importance of intraoperative neurophysiological monitoring. Future research should focus on refining target definition by integrating advanced neuroimaging techniques with real-time neurophysiological data

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