CLINICAL NEUROANATOMY OF THE SUBTHALAMIC AND SEPTAL REGION CONSIDERING THEIR ROLE IN DEEP BRAIN STIMULATION
Mészáros Cintia
Theoretical and Translational Medicine Division
Dr. Kellermayer Miklós
SE Anatómiai, Szövet- és Fejlődéstani Intézet könyvtára
2024-12-17 13:00:00
Clinical application of basic science results
Dr. Vásárhelyi Barna
Dr. Bárány László
Dr. Kozák Lajos Rudolf
Dr. Gaszner Balázs
Dr. Réthelyi János
Dr. Tamás Gertrúd
Dr. Valálik István
In the present thesis, two brain areas important for deep brain stimulation (DBS) were presented using fiber dissection and histological validation.
DBS makes it possible to modulate a specific function of certain brain areas in a reversible way. Accurate anatomical knowledge of the target area is obviously essential for the correct implantation of the stimulation electrodes. The subthalamic nucleus is currently the most used target structure primarily stimulated in Parkinson's disease. However, it is surrounded by numerous fiber bundles, the co-stimulation of which may play a role in the therapeutic or side effects.
One of these fiber bundles – based on tractography studies – is the medial forebrain bundle, which was considered to be responsible for the development of hypomanic side effects. Although this fiber bundle has been extensively studied in rodents, we still only have speculations about its course in the human brain. According to the results of this thesis, the medial forebrain bundle described by tractography is a false positive bundle resulting from the limitations of tractography and actually made up of the ansa lenticularis, the lenticular fasciculus and the anterior limb of the internal capsule.
However, stimulation of the superolateral branch of the medial forebrain bundle has been emerged as a promising DBS target in the last decade, which - based on the presented results - actually corresponds to the stimulation of the ansa lenticularis in the prerubral region. The therapeutic effect arises most likely due to the activation of the monoaminergic fibers joining it, along with the co-stimulation of the limbic cone region of the medial part of the subthalamic nucleus.
While the subthalamic region has been a stimulation target for a relatively long time, the septal region, especially its medial part is currently only stimulated in form of animal experiments, but with rather encouraging results. Therefore, it can be expected that in the future the stimulation of this region will also be approved by the authorities as a therapeutic option in human diseases and conditions, for which the topographical anatomical knowledge presented in this thesis will certainly be useful.
