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Since the introduction of deep brain stimulation (DBS) by Benabid and colleagues in 1987, this technique has become the preferred treatment for patients with various movement disorders including Parkinson’s disease (Benabid et al., 1987). Patients with advanced Parkinson’s disease (PD) who have intolerable drug-induced side effects or motor complications following the long-term use of dopaminergic drugs have shown significant improvement in symptoms such as motor fluctuation and dyskinesia following subthalamic nucleus (STN) deep brain stimulation (DBS), facilitating reductions in dosages of levodopa (Limousin et al., 1998). Significant improvements in motor function have been documented in both short-term and long-term periods (Krack et al., 2003; Benabid et al., 2005; Lyons & Pahwa, 2005; Rodriguez-Oroz et al., 2005; Deuschl et al., 2006; Kleiner-Fisman et al., 2006; Tsai et al., 2009). However, variable improvement of symptoms has been observed after STN DBS even in well-selected patients with advanced PD (Paek et al., 2008). Such individual variation was not predictable before surgery and its cause is not obvious. Differences in the extent of disease progression or constitutional differences in response to STN DBS might lead to such variation; alternatively, it might be caused by differences in the accuracy of electrode positioning in relation to the STN. The precise positioning of the electrodes in the STN is considered an important factor in achieving good clinical outcome following STN DBS. To achieve precise targeting of electrodes, many approaches have been taken; these include direct targeting based on fused images of CT-MRI, MRI-MRI, and MRI-brain atlas, as well as intra-operative microelectrode recording and intra-operative stimulation (Bejjani et al., 2000; Benazzou et al., 2002; Hamid et al., 2005; Godinho et al., 2006; Cho et al., 2010). However, many unexpected factors, such as possible brain shift due to CSF leakage, electrode artifacts in the MRI, and error in the manipulation of instruments, make it difficult to precisely position electrodes in the center of the STN (Martinez-Santiesteban et al., 2007; Miyagi et al., 2007; Halpern et al., 2008; Khan et al., 2008). Thus, following surgery, not all patients have electrodes positioned exactly in

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Estimation of Electrode Position with Fused Images of Preoperative MRI and Postoperative CT Using the Mutual Information Technique After STN DBS in Patients with Advanced Parkinson's Disease