Modelo tridimensional de estructuras mesencefálicas y protuberanciales: Se propone un abordaje para la identificación estereotáctica del núcleo tegmental pedúnculopontino

Paolo Mazzone; Giacomo Della Marca; Stefano Sposato; Vincenzo Di Lazzaro; Eugenio Scarnati

doi:10.47924/neurotarget2008342

Authors

Paolo Mazzone Cto, Asl Rmc, Roma, Italia
Giacomo Della Marca Catholic University, Rome, Italy
Stefano Sposato Cto, Asl Rmc, Roma, Italia
Vincenzo Di Lazzaro Catholic University, Rome, Italy
Eugenio Scarnati University of L'Aquila, Italy

DOI:

https://doi.org/10.47924/neurotarget2008342

Keywords:

Nucleus pedunculopontinus tegmenti, 3D model, stereotactic planning, Parkinson’s disease, brainstem

Abstract

Background: The nucleus pedunculopontinus tegmenti (PPTg) is a new target for Deep Brain Stimulation (DBS) in Parkinson’s Disease (PD), in particular for ameliorating postural abnormalities and gait disturbances. The classical surgical stereotactic technique, based on the Ca-Cp line and the Guyot’s scheme, is hardly applicable to brainstem surgery, because of the high degree of inter-individual anatomic variability.

Objective: to describe a three-dimensional modeling technique, based on neuroimaging and anatomic atlases, useful in the pre-surgical planning as well as during the intraoperative and post-surgical phases of implantation of DBS electrodes in the PPTg in humans.

Methods: 3D models, representing the most relevant anatomical structures in the midbrain and pons, were built on the basis of anatomic stereotactic atlases by means of Rhinoceros© and MedicoCad softwares used for the reconstruction and 3D modeling of the brainstem structures. The 3D models were integrated with neuroimaging (MRI, and CT images, and enriched particularly with angio-CT representation of the brain vessels).

Results: The anatomic structures included in the model were the following: PPTg, Superior Cerebellar Peduncle (SPC), Peripeduncular Nucleus (PPD), Medial Lemniscus (ML), Red Nucleus (RN), 3rd and 4th ventricle, Lamina Quadrigemina (LQ), Locus Coeruleus (LC), Periaqueductal Gray (PAG).

Discussion: The classic determination of stereotactic coordinates, obtained by using a proportional system based on ventriculography or neuroimaging, by utilizing as landmarks the Ca-Cp line and the top of the thalamus, and by adopting solely 2D stereotactic at- lases, can hardly be applied to brainstem surgery. The “direct” method of planning , based on MPR and the slides of axial stereotactic CT scan, on the overlapping of 2D Tc slides of Atlases by ‘direct’ individuation of brainstem borders, and on the 3D representation of the PPTg, permits a better adaptation to individual anatomic features.

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