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Pedunculopontine Nucleus Region Deep Brain Stimulation in Parkinson Disease: Surgical Anatomy and Terminology

Hamani, C; Aziz, T; Bloem, BR; Brown, P; Chabardes, S; Coyne, T; Foote, K; Garcia-Rill, E; Hirsch, EC; Lozano, AM; et al. Hamani, C; Aziz, T; Bloem, BR; Brown, P; Chabardes, S; Coyne, T; Foote, K; Garcia-Rill, E; Hirsch, EC; Lozano, AM; Mazzone, PA; Okun, MS; Hutchison, W; Silburn, P; Zrinzo, L; Alam, M; Goetz, L; Pereira, EAC; Rughani, A; Thevathasan, W; Moro, E; Krauss, JK (2016) Pedunculopontine Nucleus Region Deep Brain Stimulation in Parkinson Disease: Surgical Anatomy and Terminology. Stereotactic and Functional Neurosurgery, 94 (5). pp. 298-306. ISSN 1423-0372 https://doi.org/10.1159/000449010
SGUL Authors: Pereira, Erlick Abilio Coelho

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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.

Item Type: Article
Additional Information: This is the peer-reviewed but unedited manuscript version of the following article: Hamani C, Aziz T, Bloem B, R, Brown P, Chabardes S, Coyne T, Foote K, Garcia-Rill E, Hirsch E, C, Lozano A, M, Mazzone P, A, M, Okun M, S, Hutchison W, Silburn P, Zrinzo L, Alam M, Goetz L, Pereira E, Rughani A, Thevathasan W, Moro E, Krauss J, K, Pedunculopontine Nucleus Region Deep Brain Stimulation in Parkinson Disease: Surgical Anatomy and Terminology. Stereotact Funct Neurosurg 2016;94:298-306. The final, published version is available at http://www.karger.com/?doi=10.1159/000449010
Keywords: Neurology & Neurosurgery
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Stereotactic and Functional Neurosurgery
ISSN: 1423-0372
Dates:
DateEvent
1 November 2016Published
11 October 2016Published Online
8 August 2016Accepted
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
UNSPECIFIEDMedtronichttp://dx.doi.org/10.13039/100004374
URI: https://openaccess.sgul.ac.uk/id/eprint/108311
Publisher's version: https://doi.org/10.1159/000449010

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