The first observation is that preoperative volumes of BGTC and non BGTC were generally similar or larger on the ipsilateral side of the first implant (contralateral to symptom onset) as compared to the side contralateral to the implant. With the typical asymmetry of PD symptoms, one may expect that the BGTC structures contralateral to side of onset would have lower volumes; however, previous studies have illustrated that these expected asymmetries are more apparent with shape analysis when compared to absolute volumetrics, highlighting the apparent inaccuracy of pure basal ganglia volumetrics in detecting these changes (4). Ansa subthalamica exiting the anterior pole of the STN) and limbic hyperdirect pathways that largely travel anteriorly into the anterior limb of the internal capsule would not be expected to be targeted either with lead implantation or with stimulation.
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