全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用:99美元

查看量下载量

相关文章

更多...

Anatomy of the Human Subthalamic Nucleus: A Combined Morphometric Study

DOI: 10.1155/2013/319710

Full-Text   Cite this paper   Add to My Lib

Abstract:

Purpose. Our purpose was to provide a combined clinically oriented study focused on the detailed anatomy of the human STN, with great respect to its targeting. Methods. For our imaging study, we used cerebral magnetic resonance images (MRIs) from 26 neurosurgical patients and for our anatomic study 32 cerebral hemispheres from 18 normal brains from cadaver donors. We measured and analyzed the STN dimensions (based on its stereotactic coordinates). Results. At stereotactic level , the STN length was 7.7?mm on MRIs and 8.1?mm in anatomic specimens. Its width was 6?mm on MRIs and 6.3?mm in anatomic specimens. The STN was averagely visible in 3.2 transverse MRI slices and its maximum dimension was 8.5?mm. The intercommissural distance was 26.3?mm on MRIs and 27.3?mm in anatomic specimens. We found statistically significant difference of the STN width and length between individuals <60 and ≥60 years old. Conclusion. The identification of the STN limits was easier in anatomic specimens than on MRIs and easier on T2 compared to T1-weighted MRIs sections. STN dimensions appear slightly smaller on MRIs. Younger people have wider and longer STN. 1. Introduction The human subthalamic nucleus (STN) is a massive biconvex lens-shaped nucleus located under the thalamus. Among the basal ganglia nuclei, the STN has a major function in the motor cortico-basal ganglia-thalamocortical circuit and is a target site for neurosurgical treatment such as parkinsonian patients with long-term motor fluctuations and dyskinesia [1]. The motor functions of the STN were established in humans from clinical observations of contralateral hemiballism induced by STN ischemia. Its motor role was confirmed by metabolic, electrophysiological, and behavioral studies performed in healthy animals and animals’ models of Parkinson’s disease (PD) [1]. Experimental studies in animals and clinical observations of parkinsonian patients showed that the STN had also associative and limbic functions. After STN stimulation, some patients became apathetic or depressed or had impaired recognition of facial emotion [1]. Although the role of the STN in the motor cortico-basal ganglia-thalamocortical loop is well known, its implication on limbic functions remains to be described by a new scheme of the limbic loop including the STN. After chronic STN stimulation in patients with PD, many studies showed executive impairments, apathy, depression, hypomania, and impairment of recognition of negative facial emotions. The medial tip of the STN represents its limbic part. This part receives inputs from the anterior

References

[1]  C. Haegelen, T. Rouaud, P. Darnault, and X. Morandi, “The subthalamic nucleus is a key-structure of limbic basal ganglia functions,” Medical Hypotheses, vol. 72, no. 4, pp. 421–426, 2009.
[2]  F. Acar, J. P. Miller, M. C. Berk, G. Anderson, and K. J. Burchiel, “Safety of anterior commissure-posterior commissure-based target calculation of the subthalamic nucleus in functional stereotactic procedures,” Stereotactic and Functional Neurosurgery, vol. 85, no. 6, pp. 287–291, 2007.
[3]  K. Ashkan, P. Blomstedt, L. Zrinzo et al., “Variability of the subthalamic nucleus: the case for direct MRI guided targeting,” British Journal of Neurosurgery, vol. 21, no. 2, pp. 197–200, 2007.
[4]  S. Breit, J.-F. le Bas, A. Koudsie et al., “Pretargeting for the implantation of stimulation electrodes into the subthalamic nucleus: a comparative study of magnetic resonance imaging and ventriculography,” Neurosurgery, vol. 58, supplement 1, pp. S83–S94, 2006.
[5]  F. Godinho, S. Thobois, M. Magnin et al., “Subthalamic nucleus stimulation in Parkinson's disease: anatomical and electrophysiological localization of active contacts,” Journal of Neurology, vol. 253, no. 10, pp. 1347–1355, 2006.
[6]  W. Hamel, U. Fietzek, A. Morsnowski et al., “Deep brain stimulation of the subthalamic nucleus in Parkinson's disease: evaluation of active electrode contacts,” Journal of Neurology, Neurosurgery and Psychiatry, vol. 74, no. 8, pp. 1036–1046, 2003.
[7]  M. M. Lanotte, M. Rizzone, B. Bergamasco, G. Faccani, A. Melcarne, and L. Lopiano, “Deep brain stimulation of the subthalamic nucleus: anatomical, neurophysiological, and outcome correlations with the effects of stimulation,” Journal of Neurology, Neurosurgery and Psychiatry, vol. 72, no. 1, pp. 53–58, 2002.
[8]  A. Machado, A. R. Rezai, B. H. Kopell, R. E. Gross, A. D. Sharan, and A.-L. Benabid, “Deep brain stimulation for Parkinson's disease: surgical technique and perioperative management,” Movement Disorders, vol. 21, no. 14, pp. S247–S258, 2006.
[9]  S. Pinto, J.-F. le Bas, L. Castana, P. Krack, P. Pollak, and A.-L. Benabid, “Comparison of two techniques to postoperatively localize the electrode contacts used for subthalamic nucleus stimulation,” Neurosurgery, vol. 60, no. 4, supplement 2, pp. 285–292, 2007.
[10]  J. A. Saint-Cyr, T. Hoque, L. C. M. Pereira et al., “Localization of clinically effective stimulating electrodes in the human subthalamic nucleus on magnetic resonance imaging,” Journal of Neurosurgery, vol. 97, no. 5, pp. 1152–1166, 2002.
[11]  P. B. Senatus, D. Teeple, S. McClelland III et al., “A technique for minimally altering anatomically based subthalamic electrode targeting by microelectrode recording,” Neurosurgical Focus, vol. 20, no. 5, p. E8, 2006.
[12]  M. Shin, J.-P. Lefaucheur, M. F. Penholate, P. Brugières, J.-M. Gurruchaga, and J.-P. Nguyen, “Subthalamic nucleus stimulation in Parkinson's disease: postoperative CT-MRI fusion images confirm accuracy of electrode placement using intraoperative multi-unit recording,” Neurophysiologie Clinique, vol. 37, no. 6, pp. 457–466, 2007.
[13]  K. V. Slavin, K. R. Thulborn, C. Wess, and H. Nersesyan, “Direct visualization of the human subthalamic nucleus with 3T MR imaging,” American Journal of Neuroradiology, vol. 27, no. 1, pp. 80–84, 2006.
[14]  P. A. Starr, C. W. Christine, P. V. Theodosopoulos et al., “Implantation of deep brain stimulators into the subthalamic nucleus: technical approach and magnetic resonance imaging-verified lead locations,” Journal of Neurosurgery, vol. 97, no. 2, pp. 370–387, 2002.
[15]  S. Thobois, P. Mertens, M. Guenot et al., “Subthalamic nucleus stimulation in Parkinson's disease: clinical evaluation of 18 patients,” Journal of Neurology, vol. 249, no. 5, pp. 529–534, 2002.
[16]  F. Vergani, A. Landi, A. Antonini et al., “Anatomical identification of active contacts in subthalamic deep brain stimulation,” Surgical Neurology, vol. 67, no. 2, pp. 140–146, 2007.
[17]  M. S. Yoon and M. Munz, “Placement of deep brain stimulators into the subthalamic nucleus,” Stereotactic and Functional Neurosurgery, vol. 72, no. 2–4, pp. 145–149, 1999.
[18]  W.-G. Shen, H.-Y. Wang, Z.-G. Lin et al., “Stereotactic localization and visualization of the subthalamic nucleus,” Chinese Medical Journal, vol. 122, no. 20, pp. 2438–2443, 2009.
[19]  S. Daniluk, K. G. Davies, S. A. Ellias, P. Novak, and J. M. Nazzaro, “Assessment of the variability in the anatomical position and size of the subthalamic nucleus among patients with advanced Parkinson's disease using magnetic resonance imaging,” Acta Neurochirurgica, vol. 152, no. 2, pp. 201–210, 2010.
[20]  E. O. Richter, T. Hoque, W. Halliday, A. M. Lozano, and J. A. Saint-Cyr, “Determining the position and size of the subthalamic nucleus based on magnetic resonance imaging results in patients with advanced Parkinson disease,” Journal of Neurosurgery, vol. 100, no. 3, pp. 541–546, 2004.
[21]  F. Caire, L. Ouchchane, J. Coste et al., “Subthalamic nucleus location: relationships between stereotactic AC-PC-based diagrams and MRI anatomy-based contours,” Stereotactic and Functional Neurosurgery, vol. 87, no. 6, pp. 337–347, 2009.
[22]  H. Lange, G. Thorner, and A. Hopf, “Morphometric-statistical structure analysis of human striatum, pallidum and nucleus su-thalamicus. III. Nucleus subthalamicus,” Journal für Hirnforschung, vol. 17, no. 1, pp. 31–41, 1976.
[23]  J. Talairach, M. David, P. Tournoux, H. Corredor, and T. Kvasina, Atlas d’anatomie stéréotaxique. Repérage radiologique indirect des noyaux gris centraux des régions mésencéphalo-sous-optiques et hypothalamiques de l’homme, Masson et Cie, Paris, France, 1957.
[24]  A. L. Benabid, A. Koudsie, A. Benazzouz, J.-F. le Bas, and P. Pollak, “Imaging of subthalamic nucleus and ventralis intermedius of the thalamus,” Movement Disorders, vol. 17, supplement 3, pp. S123–S129, 2002.

Full-Text

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133