caa a22 4500 445376945 CHVBK 20180317143005.0 cr unu---uuuuu 170323e20111001xx s 000 0 eng 10.1007/s00702-011-0593-x doi (NATIONALLICENCE)springer-10.1007/s00702-011-0593-x The deep brain stimulation of the pedunculopontine tegmental nucleus: towards a new stereotactic neurosurgery [Elektronische Daten] [Paolo Mazzone, Stefano Sposato, Angelo Insola, Eugenio Scarnati] 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 angio-computerized tomography (angio-CT) 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 implantations. Springer-Verlag, 2011 Somatosensory evoked potentials nationallicence Intraoperative microrecordings nationallicence Local field potentials nationallicence Blink reflex nationallicence Gait analysis nationallicence Jaw movements nationallicence Mazzone Paolo Functional and Stereotactic Neurosurgery, CTO Hospital ASL Roma C, Via San Nemesio 21, 00145, Rome, Italy aut Sposato Stefano Neuroradiology, CTO Hospital ASL Roma C, Via San Nemesio 21, 00145, Rome, Italy aut Insola Angelo Clinical Neurophysiopathology, CTO Hospital ASL Roma C, Via San Nemesio 21, 00145, Rome, Italy aut Scarnati Eugenio Department of Biomedical Sciences and Technologies (STB), University of L'Aquila, Via Vetoio Coppito 2, 67100, L'Aquila, Italy aut Journal of Neural Transmission Springer Vienna 118/10(2011-10-01), 1431-1451 0300-9564 118:10<1431 2011 118 702 https://doi.org/10.1007/s00702-011-0593-x text/html Onlinezugriff via DOI 1 review-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00702-011-0593-x text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Mazzone Paolo Functional and Stereotactic Neurosurgery, CTO Hospital ASL Roma C, Via San Nemesio 21, 00145, Rome, Italy aut NATIONALLICENCE 700 1- Sposato Stefano Neuroradiology, CTO Hospital ASL Roma C, Via San Nemesio 21, 00145, Rome, Italy aut NATIONALLICENCE 700 1- Insola Angelo Clinical Neurophysiopathology, CTO Hospital ASL Roma C, Via San Nemesio 21, 00145, Rome, Italy aut NATIONALLICENCE 700 1- Scarnati Eugenio Department of Biomedical Sciences and Technologies (STB), University of L'Aquila, Via Vetoio Coppito 2, 67100, L'Aquila, Italy aut NATIONALLICENCE 773 0- Journal of Neural Transmission Springer Vienna 118/10(2011-10-01), 1431-1451 0300-9564 118:10<1431 2011 118 702 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer