Neurological Surgery 脳神経外科49巻4号

2021年07月発行

特集 定位・機能神経外科の基礎と臨床 Ⅰ　定位・機能神経外科に必須な基礎知識

臨床に役立つ大脳基底核の解剖

著者： 川崎隆¹² 木村唯子¹ 辛正廣¹ 新井信隆³

所属機関： ¹東京都立神経病院脳神経外科 ²横浜市立大学附属市民総合医療センター脳神経外科 ³東京都医学総合研究所神経病理解析室

ページ範囲：P.724 - P.736

Point
・視床下核（STN）は脳標本上は境界明瞭に同定される．上方にはForel H野，下方には黒質が位置する．
・淡蒼球外節（GPe）と内節（GPi）は線維組織により境界される．視索はGPiの直下にある．
・視床亜核はMRI，脳組織標本の肉眼所見では区別は不可能だが，顕微鏡下に細胞構築により区別できる．
・脚橋被蓋核（PPN）は下丘レベルで，上小脳脚と内側毛帯にはさまれた三日月型の灰白質である．
・Posterior subthalamic area（PSA）はSTN後方の白質で，不確帯後部との境界は不明瞭である．

参考文献

1）Schaltenbrand G, Wahren W：Atlas for Stereotaxy of the Human Brain：With an Accompanying Guide. Thieme Medical Publishers, New York, 1977

2）Niemann K, et al：Verification of the Schaltenbrand and Wahren stereotactic atlas. Acta Neurochir（Wien）129：72-81, 1994

3）Nowinski WL：Towards construction of an ideal stereotactic brain atlas. Acta Neurochir（Wien）150：1-13；discussion 13-14, 2008

4）Kawasaki T, et al：Topographic anatomy of the subthalamic nucleus localized by high-resolution human brain atlas superimposing digital images of cross-sectioned surfaces and histological images of microscopic sections from frozen cadaveric brains. J Clin Neurosci 53：193-202, 2018

5）谷口　真，新井信隆：パーキンソン病に対する定位脳手術に必要な解剖知識．大畑建治（編）：顕微鏡下手術のための脳神経外科解剖XIII—解剖から理解する脳神経外科手術の基本．サイメッド・パブリケーションズ，東京，2001

6）Gallay MN, et al：MRgFUS pallidothalamic tractotomy for chronic therapy-resistant Parkinson's disease in 51 consecutive patients：single center experience. Front Surg 6：76, 2019.

7）Parent M, Parent A：The pallidofugal motor fiber system in primates. Parkinsonism Relat Disord 10：203-211, 2004

8）Morel A：Stereotactic Atlas of the Human Thalamus and Basal Ganglia. CRC Press, Florida, 2007

9）Hamani C, et al：The motor thalamus in neurosurgery. Neurosurgery 58：146-158；discussion 146-158, 2006

10）Lemaire JJ, et al：Anatomy of the human thalamus based on spontaneous contrast and microscopic voxels in high-field magnetic resonance imaging. Neurosurgery 66（3 Suppl Operative）：161-172, 2010

11）Hirai T, Jones EG：A new parcellation of the human thalamus on the basis of histochemical staining. Brain Res Brain Res Rev 14：1-34, 1989

12）平井達夫，菊地正昭：ヒト視床の亜核分類．駒井則彦（監修），板倉　徹，他（編著）：定位脳手術．金芳堂，京都，1998

13）Garcia-Rill E, et al：Locomotion-inducing sites in the vicinity of the pedunculopontine nucleus. Brain Res Bull 18：731-738, 1987

14）高草木薫：大脳基底核による運動の制御．臨床神経 49：325-334, 2009

15）Takakusaki K, et al：Brainstem control of locomotion and muscle tone with special reference to the role of the mesopontine tegmentum and medullary reticulospinal systems. J Neural Transm（Vienna）123：695-729, 2016

16）Mazzone P, et al：Implantation of human pedunculopontine nucleus：a safe and clinically relevant target in Parkinson's disease. Neuroreport 16：1877-1881, 2005

17）Plaha P, Gill SS：Bilateral deep brain stimulation of the pedunculopontine nucleus for Parkinson's disease. Neuroreport 16：1883-1887, 2005

18）Mazzone P, et al：Stereotactic surgery of nucleus tegmenti pedunculopontine［corrected］. Br J Neurosurg 22（Suppl 1）：S33-S40, 2008

19）Alessandro S, et al：Non-motor functions in parkinsonian patients implanted in the pedunculopontine nucleus：focus on sleep and cognitive domains. J Neurol Sci 289：44-48, 2010

20）Costa A, et al：Effects of deep brain stimulation of the peduncolopontine area on working memory tasks in patients with Parkinson's disease. Parkinsonism Relat Disord 16：64-67, 2010

21）Ferraye MU, et al：Effects of pedunculopontine nucleus area stimulation on gait disorders in Parkinson's disease. Brain 133（Pt 1）：205-214, 2010

22）Moro E, et al：Unilateral pedunculopontine stimulation improves falls in Parkinson's disease. Brain 133（Pt 1）：215-224, 2010

23）Khan S, et al：Outcomes from stimulation of the caudal zona incerta and pedunculopontine nucleus in patients with Parkinson's disease. Br J Neurosurg 25：273-280, 2011

24）Stefani A, et al：Bilateral deep brain stimulation of the pedunculopontine and subthalamic nuclei in severe Parkinson's disease. Brain 130（Pt 6）：1596-1607, 2007

25）Zrinzo L, et al：The pedunculopontine and peripeduncular nuclei：a tale of two structures. Brain 130（Pt 6）：e73；author reply e74, 2007

26）Mazzone P, et al：Reply：the peripeduncular and pedunculopontine nuclei：a putative dispute not discouraging the effort to define a clinically relevant target. Brain 130：e74, 2007

27）Yelnik J：PPN or PPD, what is the target for deep brain stimulation in Parkinson's disease? Brain 130（Pt 9）：e79；author reply e80, 2007

28）Mesulam MM, et al：Human reticular formation：cholinergic neurons of the pedunculopontine and laterodorsal tegmental nuclei and some cytochemical comparisons to forebrain cholinergic neurons. J Comp Neurol 281：611-633, 1989

29）Takakusaki K, et al：Cholinergic and noncholinergic tegmental pedunculopontine projection neurons in rats revealed by intracellular labeling. J Comp Neurol 371：345-361, 1996

30）Manaye KF, et al：Quantification of cholinergic and select non-cholinergic mesopontine neuronal populations in the human brain. Neuroscience 89：759-770, 1999

31）Zrinzo L, Zrinzo LV：Surgical anatomy of the pedunculopontine and peripeduncular nuclei. Br J Neurosurg 22（Suppl 1）：S19-S24, 2008

32）Zrinzo L, et al：Targeting of the pedunculopontine nucleus by an MRI-guided approach：a cadaver study. J Neural Transm（Vienna）118：1487-1495, 2011

33）Blomstedt P, et al：The posterior subthalamic area in the treatment of movement disorders：past, present, and future. Neurosurgery 64：1029-1038；discussion 1038-1042, 2009

34）Murata J, et al：Electrical stimulation of the posterior subthalamic area for the treatment of intractable proximal tremo. J Neurosurg 99：708-715, 2003

35）Jiménez F, et al：Subthalamic prelemniscal radiation stimulation for the treatment of Parkinson's disease：electrophysiological characterization of the area. Arch Med Res 31：270-281, 2000

36）Plaha P, et al：Stimulation of the caudal zona incerta is superior to stimulation of the subthalamic nucleus in improving contralateral parkinsonism. Brain 129（Pt 7）：1732-1747, 2006

37）Blomstedt P, et al：Unilateral caudal zona incerta deep brain stimulation for Parkinsonian tremor. Parkinsonism Relat Disord 18：1062-1066, 2012

38）Fytagoridis A, et al：Stimulation-induced side effects in the posterior subthalamic area：distribution, characteristics and visualization. Clin Neurol Neurosurg 115：65-71, 2013

39）Sturm V, et al：The nucleus accumbens：a target for deep brain stimulation in obsessive-compulsive- and anxiety-disorders. J Chem Neuroanat 26：293-299, 2003

40）Rauch SL, et al：A functional neuroimaging investigation of deep brain stimulation in patients with obsessive—compulsive disorder. J Neurosurg 104：558-565, 2006

41）Malone DA Jr, et al：Deep brain stimulation of the ventral capsule/ventral striatum for treatment-resistant depression. Biol Psychiatry 65：267-275, 2009

42）Bewernick BH, et al：Nucleus accumbens deep brain stimulation decreases ratings of depression and anxiety in treatment-resistant depression. Biol Psychiatry 67：110-116, 2010

43）Nuttin B, et al：Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. Lancet 354：1526, 1999

44）Nuttin BJ, et al：Long-term electrical capsular stimulation in patients with obsessive-compulsive disorder. Neurosurgery 52：1263-1272；discussion 1272-1274, 2003

45）Flaherty AW, et al：Deep brain stimulation of the anterior internal capsule for the treatment of Tourette syndrome：technical case report. Neurosurgery 57（4 Suppl）：E403；discussion E403, 2005

46）Haq IU, et al：A case of mania following deep brain stimulation for obsessive compulsive disorder. Stereotact Funct Neurosurg 88：322-328, 2010

47）Turnbull IM, et al：Stimulation of the basal nucleus of meynert in senile dementia of Alzheimer's type. A preliminary report. Appl Neurophysiol 48：216-221, 1985

48）Freund HJ, et al：Cognitive functions in a patient with Parkinson-dementia syndrome undergoing deep brain stimulation. Arch Neurol 66：781-785, 2009

49）Kuhn J, et al：Deep brain stimulation of the nucleus basalis of Meynert in Alzheimer's dementia. Mol Psychiatry 20：353-360, 2015

50）Gratwicke J, et al：Bilateral deep brain stimulation of the nucleus basalis of Meynert for Parkinson disease dementia：a randomized clinical trial. JAMA Neurol 75：169-178, 2018