Hamani, C;
Aziz, T;
Bloem, BR;
Brown, P;
Chabardes, S;
Coyne, T;
Foote, K;
... Krauss, JK; + view all
(2016)
Pedunculopontine Nucleus Region Deep Brain Stimulation in Parkinson Disease: Surgical Anatomy and Terminology.
Stereotactic and Functional Neurosurgery
, 94
(5)
pp. 298-306.
10.1159/000449010.
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Abstract
Several lines of evidence over the last few years have been important in ascertaining that the pedunculopontine nucleus (PPN) region could be considered as a potential target for deep brain stimulation (DBS) to treat freezing and other problems as part of a spectrum of gait disorders in Parkinson disease and other akinetic movement disorders. Since the introduction of PPN DBS, a variety of clinical studies have been published. Most indicate improvements in freezing and falls in patients who are severely affected by these problems. The results across patients, however, have been variable, perhaps reflecting patient selection, heterogeneity in target selection and differences in surgical methodology and stimulation settings. Here we outline both the accumulated knowledge and the domains of uncertainty in surgical anatomy and terminology. Specific topics were assigned to groups of experts, and this work was accumulated and reviewed by the executive committee of the working group. Areas of disagreement were discussed and modified accordingly until a consensus could be reached. We demonstrate that both the anatomy and the functional role of the PPN region need further study. The borders of the PPN and of adjacent nuclei differ when different brainstem atlases and atlas slices are compared. It is difficult to delineate precisely the PPN pars dissipata from the nucleus cuneiformis, as these structures partially overlap. This lack of clarity contributes to the difficulty in targeting and determining the exact localization of the electrodes implanted in patients with akinetic gait disorders. Future clinical studies need to consider these issues.
| Type: | Article |
|---|---|
| Title: | Pedunculopontine Nucleus Region Deep Brain Stimulation in Parkinson Disease: Surgical Anatomy and Terminology |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1159/000449010 |
| Publisher version: | http://dx.doi.org/10.1159/000449010 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Science & Technology, Life Sciences & Biomedicine, Neurosciences, Neuroimaging, Surgery, Neurosciences & Neurology, Anatomy, Brainstem, Deep brain stimulation, Pedunculopontine nucleus, Parkinson disease, PROGRESSIVE SUPRANUCLEAR PALSY, LATERODORSAL TEGMENTAL NUCLEI, CHOLINERGIC NEURONS, RETICULAR-FORMATION, BASAL GANGLIA, EFFERENT CONNECTIONS, SUBTHALAMIC NUCLEUS, SQUIRREL-MONKEY, RAT, LESIONS |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Clinical and Movement Neurosciences |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/1529107 |
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