BACKGROUND The subthalamic nucleus (STN), globus pallidus internus (GPi), and pedunculopontine nucleus (PPN) are effective targets for deep brain stimulation (DBS) in many pathological conditions. Previous literature has focused on appropriate stimulation targets and their relationships with functional neuroanatomic pathways; however, comprehensive anatomic dissections illustrating these nuclei and their connections are lacking. This information will provide insight into the anatomic basis of stimulation-induced DBS benefits and side effects. OBJECTIVE To combine advanced cadaveric dissection techniques and ultrahigh field magnetic resonance imaging (MRI) to explore the anatomy of the STN, GPi, and PPN with their associated fiber pathways. METHODS A total of 10 cadaveric human brains and 2 hemispheres of a cadaveric head were examined using fiber dissection techniques. The anatomic dissections were compared with 11.1 Tesla (T) structural MRI and 4.7 T MRI fiber tractography. RESULTS The extensive connections of the STN (caudate nucleus, putamen, medial frontal cortex, substantia innominata, substantia nigra, PPN, globus pallidus externus (GPe), GPi, olfactory tubercle, hypothalamus, and mammillary body) were demonstrated. The connections of GPi to the thalamus, substantia nigra, STN, amygdala, putamen, PPN, and GPe were also illustrated. The PPN was shown to connect to the STN and GPi anteriorly, to the cerebellum inferiorly, and to the substantia nigra anteriorly and superiorly. CONCLUSION This study demonstrates connections using combined anatomic microdissections, ultrahigh field MRI, and MRI tractography. The anatomic findings are analyzed in relation to various stimulation-induced clinical effects. Precise knowledge of neuroanatomy, anatomic relationships, and fiber connections of the STN, GPi, PPN will likely enable more effective targeting and improved DBS outcomes.

中文翻译：

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病灶和深部脑刺激手术常见靶点的死后解剖

背景丘脑底核（STN）、苍白球内部（GPi）和桥脑桥核（PPN）是许多病理条件下深部脑刺激（DBS）的有效靶点。以前的文献侧重于适当的刺激目标及其与功能性神经解剖学通路的关系；然而，缺乏说明这些细胞核及其连接的全面解剖学解剖。该信息将提供对刺激引起的 DBS 益处和副作用的解剖学基础的深入了解。目的 结合先进的尸体解剖技术和超高场磁共振成像 (MRI)，探索 STN、GPi 和 PPN 及其相关纤维通路的解剖结构。方法 使用纤维解剖技术检查了总共 10 具尸体人脑和尸体头部的 2 个半球。将解剖夹层与 11.1 特斯拉 (T) 结构 MRI 和 4.7 T MRI 纤维束成像进行比较。结果证明了 STN（尾状核、壳核、内侧额叶皮层、无名质、黑质、PPN、苍白球外层（GPe）、GPi、嗅结节、下丘脑和乳头体）的广泛连接。还说明了 GPi 与丘脑、黑质、STN、杏仁核、壳核、PPN 和 GPe 的连接。显示 PPN 连接到前部的 STN 和 GPi，下连接到小脑，前部和上连接到黑质。结论 本研究展示了使用组合解剖显微切割的连接，超高场 MRI 和 MRI 纤维束成像。解剖学发现与各种刺激引起的临床效应有关。准确了解 STN、GPi、PPN 的神经解剖学、解剖关系和纤维连接，可能会实现更有效的靶向和改善 DBS 结果。