*Stereotactic and Functional Neurosurgery, CTO Hospital, ASL RMC, Rome, Italy ‡Neuroradiology, CTO Hospital, ASL RMC, Rome, Italy §Neurophysiopathology, CTO Hospital, ASL RMC, Rome, Italy ¶Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, L'Aquila, Italy.
Neurosurgery. 2013 Nov;73(5):894-906; discussion 905-6. doi: 10.1227/NEU.0000000000000108.
The pedunculopontine tegmental nucleus (PPTg) is a novel target for deep brain stimulation (DBS) in movement disorders.
To clarify the relationships between the individual anatomic variations of the brainstem, the site in which the PPTg DBS is applied, and the clinical outcome in a relatively large number of patients affected by Parkinson disease or progressive supranuclear palsy.
Magnetic resonance images have been used to evaluate brainstem anatomy and the relationships between lead position and specific brainstem landmarks. All data were matched on atlas representations of the PPTg and were correlated with Unified Parkinson Disease Rating Scale III (UPDRS III), subitems 27 to 30 of UPDRS III and the Hoehn and Yahr evaluations.
A high variance of brainstem parameters was evident, affecting the relationships between the position of the nucleus and lead contacts. According to the contacts giving the best clinical outcome, patients could be distinguished between those who required the use of 2 adjacent contacts and those who required stimulation through 2 nonadjacent contacts. Furthermore, in the former group the target coordinates were more lateral and deeper compared with the latter group.
Individual PPTg-DBS planning is required to overcome the inconsistencies linked to the high variability in the brainstem anatomy of patients. The lack of correlations between lead position, contact setup, and clinical outcome indicate that the benefits of PPTg DBS may not be strictly linked to the site of stimulation within the PPTg area, and may not depend upon the neurons still surviving in this region in Parkinson disease or progressive supranuclear palsy.
脑桥被盖核（PPTg）是深部脑刺激（DBS）治疗运动障碍的新靶点。
阐明大量帕金森病或进行性核上性麻痹患者的脑干部位个体解剖变异、应用 PPTg DBS 的部位与临床结果之间的关系。
使用磁共振成像评估脑干部位解剖结构以及导丝位置与特定脑干部位标志物之间的关系。所有数据均基于 PPTg 的图谱表示进行匹配，并与帕金森病统一评定量表第三部分（UPDRS III）、UPDRS III 的第 27 至 30 项亚项和 Hoehn 和 Yahr 评估相关联。
脑干部位参数存在较大差异，影响了核位置与导丝接触点之间的关系。根据产生最佳临床效果的接触点，可以将患者分为需要使用 2 个相邻接触点和需要使用 2 个非相邻接触点的两组。此外，在前一组中，目标坐标比后一组更偏侧和更深。
需要进行个体化的 PPTg-DBS 规划，以克服与患者脑干部位解剖结构高度变异性相关的不一致性。导丝位置、接触点设置与临床结果之间缺乏相关性表明，PPTg DBS 的益处可能与 PPTg 区域内刺激部位并不严格相关，并且可能与帕金森病或进行性核上性麻痹患者该区域内仍存活的神经元无关。
