The deep brain stimulation of the pedunculopontine

Authors: Paolo Mazzone Stefano Sposato Angelo Insola Eugenio Scarnati

Publish Date: 2011/02/12

Volume: 118, Issue: 10, Pages: 1431-1451

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Abstract

The application of deep brain stimulation DBS to the pedunculopontine tegmental nucleus PPTg has required profound modifications of classic neurosurgical techniques and of the criteria for evaluation of clinical results This review analyzes a novel method of targeting the PPTg based on angiocomputerized tomography angioCT scans and the tridimensional reconstruction of nuclei and cerebral vessels and considers the advantages of applying these methods in comparison to the more traditional approach based on reference points obtained through the evaluation of the bicommessural line Validation of the results obtained following unilateral PPTg DBS through neurophysiological recordings and objective measurements of functional parameters suggests that the PPTg may be considered as an initial target for the treatment of motor symptoms in selected patients affected by idiopathic Parkinson’s disease PD which if required could be followed by DBS of other target areas Moreover on the basis of the observations derived from stimulating the PPTg the potential utility attributed up to date to intraoperative neurophysiological recordings for identifying neurosurgical targets should be revisited and the need for changes in the intraoperative management of patients has arisen from the body of evidence accumulated over recent years The results obtained by different groups following PPTg DBS in parkinsonian patients are not uniform most likely due to a cautious acceptance of this methodology the experience progressively acquired the criteria for patient selection and to subtle differences in target location Although the role of PPTg in PD and/or in other pathologies remains to be clarified pursuing the traditional approach on classical basal ganglia targets may limit the perspective of DBS based on multiple implantationsThe authors wish to thank Dr Marco Paoloni University of Rome La Sapienza for carrying out gait analysis Dr Gianni Falise University of Rome La Sapienza for evaluating oromandibular movements and Dr Guido Vagliasindi University of Catania for evaluating the lead electrical field ES was supported by grants from MIUR Cofin 2008 and University of L’Aquila Paolo Mazzone wishes to dedicate this paper to the voice of the Japanese soprano Akiko Taniguchi

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