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Regional anatomy of the pedunculopontine nucleus: Relevance for deep brain stimulation

Authors

  • Marie-Pierre Fournier-Gosselin MD,

    1. Division of Neurosurgery, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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  • Nir Lipsman MD,

    1. Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Jean A. Saint-Cyr PhD,

    1. Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Clement Hamani MD, PhD,

    1. Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Andres M. Lozano MD, PhD

    Corresponding author
    1. Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
    • Correspondence to: Dr. Andres M. Lozano, Department of Neurosurgery, Toronto Western Hospital, University Health Network, 399, Bathurst Street WW 4-447, Toronto, ON M5T 2S8, Canada lozano@uhnresearch.ca

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  • Relevant conflicts of interest/financial disclosures: Andres M. Lozano is a consultant for Medtronic and St Jude Medical and holds the RR Tasker Chair and a Canada Research Chair in Neuroscience. Clement Hamani is a consultant for St Jude Medical.

  • Full financial disclosures and author roles may be found in the Acknowledgments section online.

ABSTRACT

The pedunculopontine nucleus (PPN) is currently being investigated as a potential deep brain stimulation target to improve gait and posture in Parkinson's disease. This review examines the complex anatomy of the PPN region and suggests a functional mapping of the surrounding nuclei and fiber tracts that may serve as a guide to a more accurate placement of electrodes while avoiding potentially adverse effects. The relationships of the PPN were examined in different human brain atlases. Schematic representations of those structures in the vicinity of the PPN were generated and correlated with their potential stimulation effects. By providing a functional map and representative schematics of the PPN region, we hope to optimize the placement of deep brain stimulation electrodes, thereby maximizing safety and clinical efficacy. © 2013 International Parkinson and Movement Disorder Society

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