Pedunculopontine nucleus region deep brain stimulation in Parkinson disease: surgical techniques, side effects, and postoperative imaging

Hamani, Clement, Lozano, Andres M., Mazzone, Paolo A. M., Moro, Elena, Hutchison, William, Silburn, Peter A., Zrinzo, Ludvic, Alam, Mesbah, Goetz, Laurent, Pereira, Erlick, Rughani, Anand, Thevathasan, Wesley, Aziz, Tipu, Bloem, Bastiaan R., Brown, Peter, Chabardes, Stephan, Coyne, Terry, Foote, Kelly, Garcia-Rill, Edgar, Hirsch, Etienne C., Okun, Michael S. and Krauss, Joachim K. (2016) Pedunculopontine nucleus region deep brain stimulation in Parkinson disease: surgical techniques, side effects, and postoperative imaging. Stereotactic and Functional Neurosurgery, 94 5: 307-319. doi:10.1159/000449011


Author Hamani, Clement
Lozano, Andres M.
Mazzone, Paolo A. M.
Moro, Elena
Hutchison, William
Silburn, Peter A.
Zrinzo, Ludvic
Alam, Mesbah
Goetz, Laurent
Pereira, Erlick
Rughani, Anand
Thevathasan, Wesley
Aziz, Tipu
Bloem, Bastiaan R.
Brown, Peter
Chabardes, Stephan
Coyne, Terry
Foote, Kelly
Garcia-Rill, Edgar
Hirsch, Etienne C.
Okun, Michael S.
Krauss, Joachim K.
Title Pedunculopontine nucleus region deep brain stimulation in Parkinson disease: surgical techniques, side effects, and postoperative imaging
Journal name Stereotactic and Functional Neurosurgery   Check publisher's open access policy
ISSN 1423-0372
1011-6125
Publication date 2016-11-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1159/000449011
Open Access Status Not yet assessed
Volume 94
Issue 5
Start page 307
End page 319
Total pages 13
Place of publication Basel, Switzerland
Publisher S. Karger AG
Language eng
Abstract The pedunculopontine nucleus (PPN) region has received considerable attention in clinical studies as a target for deep brain stimulation (DBS) in Parkinson disease. These studies have yielded variable results with an overall impression of improvement in falls and freezing in many but not all patients treated. We evaluated the available data on the surgi- cal anatomy and terminology of the PPN region in a companion paper. Here we focus on issues concerning surgical technique, imaging, and early side effects of surgery. The aim of this paper was to gain more insight into the reasoning for choosing specific techniques and to discuss shortcomings of available studies. Our data demonstrate the wide range in almost all fields which were investigated. There are a number of important challenges to be resolved, such as identification of the optimal target, the choice of the surgical approach to optimize electrode placement, the impact on the outcome of specific surgical techniques, the reliability of intraoperative confirmation of the target, and methodological differences in postoperative validation of the electrode position. There is considerable variability both within and across groups, the overall experience with PPN DBS is still limited, and there is a lack of controlled trials. Despite these challenges, the procedure seems to provide benefit to selected patients and appears to be relatively safe. One important limitation in comparing studies from different centers and analyzing outcomes is the great variability in targeting and surgical techniques, as shown in our paper. The challenges we identified will be of relevance when designing future studies to better address several controversial issues. We hope that the data we accumulated may facilitate the development of surgical protocols for PPN DBS.
Keyword Brainstem
Deep brain stimulation
Imaging
Parkinson disease
Pedunculopontine nucleus
Side effects
Stereotactic technique
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: UQ Centre for Clinical Research Publications
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Citation counts: TR Web of Science Citation Count  Cited 6 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 7 times in Scopus Article | Citations
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