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Targeting of the pedunculopontine nucleus by an MRI-guided approach: a cadaver study

  • Basic Neurosciences, Genetics and Immunology - Original Article
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Abstract

Laboratory evidence suggests that the pedunculopontine nucleus (PPN) plays a central role in the initiation and maintenance of gait. Translational research has led to reports on deep brain stimulation (DBS) of the rostral brainstem in parkinsonian patients. However, initial clinical results appear to be rather variable. Possible factors include patient selection and the wide variability in anatomical location of implanted electrodes. Clinical studies on PPN DBS efficacy would, therefore, benefit from an accurate and reproducible method of stereotactic localization of the nucleus. The present study evaluates the anatomical accuracy of a specific protocol for MRI-guided stereotactic targeting of the PPN in a human cadaver. Imaging at 1.5 and 9.4 T confirmed electrode location in the intended region as defined anatomically by the surrounding fiber tracts. The spatial relations of each electrode track to the nucleus were explored by subsequent histological examination. This confirmed that the neuropil surrounding each electrode track contained scattered large neurons morphologically consistent with those of the subnucleus dissipatus and compactus of the PPN. The results support the accuracy of the described specific MR imaging protocol.

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Acknowledgments

This work was undertaken at UCL/UCLH and was partly funded by the Department of Health NIHR Biomedical Research Centers funding scheme. The Unit of Functional Neurosurgery, Queen Square, London is supported by the Parkinson’s Appeal. MIH is supported by the Parkinson’s disease society of Sweden. JH is supported by the Reta Lila Weston Institute for Neurological Studies. JH and TR are supported by the Alzheimer’s Research Trust, the Multiple System Atrophy Trust, the Progressive Supranuclear Palsy (Europe) Association and Brain Net Europe. LAM is supported by a Grant from the PSP (Europe) Association. We wish to acknowledge the support of Professor Marie-Therese Camilleri-Podestà and Dr Pierre Schembri Wismayer from the Department of Anatomy, Genetics and Cell Biology, University of Malta and of Mr Joe Castillo from the Radiology Department, Mater Dei Hospital, Malta. We are grateful to Medtronic for supplying the electrodes and planning software and to Elekta for providing a Leksell frame for the duration of the study.

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Authors and Affiliations

  1. Unit of Functional Neurosurgery, Box 146, Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK

    Ludvic Zrinzo, Patricia Limousin & Marwan I. Hariz

  2. Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK

    Ludvic Zrinzo

  3. Department of Anatomy, Genetics and Cell Biology, University of Malta, Msida, 2080, Malta

    Laurence V. Zrinzo

  4. Sara Koe PSP Research Centre, UCL Institute of Neurology, 1 Wakefield Street, London, WC1N 1PJ, UK

    Luke A. Massey

  5. Lysholm Department of Neuroradiology, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK

    John Thornton, Mark White & Tarek A. Yousry

  6. Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK

    John Thornton & Harold G. Parkes

  7. Department of Neuroinflammation, UCL Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK

    Harold G. Parkes

  8. Queen Square Brain Bank, Department of Molecular Neuroscience, UCL Institute of Neurology, 1 Wakefield Street, London, WC1N 1PJ, UK

    Catherine Strand, Tamas Revesz & Janice L. Holton

  9. Department of Clinical Neuroscience, Umeå University, Umeå, Sweden

    Marwan I. Hariz

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  1. Ludvic Zrinzo
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  2. Laurence V. Zrinzo
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Correspondence to Ludvic Zrinzo.

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Zrinzo, L., Zrinzo, L.V., Massey, L.A. et al. Targeting of the pedunculopontine nucleus by an MRI-guided approach: a cadaver study. J Neural Transm 118, 1487–1495 (2011). https://doi.org/10.1007/s00702-011-0639-0

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  • DOI: https://doi.org/10.1007/s00702-011-0639-0

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