Pedunculopontine nucleus region deep brain stimulation in Parkinson disease: surgical anatomy and terminology

Hamani, Clement, Aziz, Tipu, Bloem, Bastiaan R., Brown, Peter, Chabardes, Stephan, Coyne, Terry, Foote, Kelly, Garcia-Rill, Edgar, Hirsch, Etienne C., Lozano, Andres M., Mazzone, Paolo A. M., Okun, Michael S., Hutchison, William, Silburn, Peter, Zrinzo, Ludvic, Alam, Mesbah, Goetz, Laurent, Pereira, Erlick, Rughani, Anand, Thevathasan, Wesley, Moro, Elena and Krauss, Joachim K. (2016) Pedunculopontine nucleus region deep brain stimulation in Parkinson disease: surgical anatomy and terminology. Stereotactic and Functional Neurosurgery, 94 5: 298-306. doi:10.1159/000449010

Author Hamani, Clement
Aziz, Tipu
Bloem, Bastiaan R.
Brown, Peter
Chabardes, Stephan
Coyne, Terry
Foote, Kelly
Garcia-Rill, Edgar
Hirsch, Etienne C.
Lozano, Andres M.
Mazzone, Paolo A. M.
Okun, Michael S.
Hutchison, William
Silburn, Peter
Zrinzo, Ludvic
Alam, Mesbah
Goetz, Laurent
Pereira, Erlick
Rughani, Anand
Thevathasan, Wesley
Moro, Elena
Krauss, Joachim K.
Title Pedunculopontine nucleus region deep brain stimulation in Parkinson disease: surgical anatomy and terminology
Journal name Stereotactic and Functional Neurosurgery   Check publisher's open access policy
ISSN 1423-0372
Publication date 2016-11-01
Sub-type Article (original research)
DOI 10.1159/000449010
Open Access Status Not yet assessed
Volume 94
Issue 5
Start page 298
End page 306
Total pages 9
Place of publication Basel, Switzerland
Publisher S. Karger AG
Language eng
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.
Keyword Anatomy
Deep brain stimulation
Parkinson disease
Pedunculopontine nucleus
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
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