Re-engineering the subthalamus.
Re-engineering the subthalamus.
复制标题
重新设计底丘脑。
DOI：
10.1016/j.wneu.2012.05.014
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发表时间：
2013
影响因子：
2
通讯作者：
Turner,DennisA
中科院分区：
文献类型：
--
作者：
Turner,DennisA
这个被称为“丘脑底”的区域的历史小插曲是及时的，并提出了我们目前关于这个区域的概念是如何演变成目前临床治疗方案的高度临床重要性的。这篇对较早文献（特别是1990年以前）的相关综述强调了以前关于该区域功能和治疗的概念是如何被重新定义和改进的（1）。尽管现在大多数对该区域的治疗都集中在运动障碍（即震颤和帕金森病）上，但这一小插曲概述了曾经被认为涉及下丘脑的各种其他疾病，包括癫痫（16），慢性疼痛和行为障碍，因为神经外科医生正在尝试定义该区域的功能。此外，作者还包括以前的治疗模式，（即，各种形式的损伤，以前产生治疗效果的支柱），现在大多被脑深部电刺激（DBS）的长期电刺激，改变长期细胞功能的基因治疗方法以及其他生物或细胞治疗所取代，所有这些都集中在功能的增强而不是损伤上。大致定义为AC-PC线以下的间脑区域在丘脑的腹侧（因此在丘脑的腹侧）、内囊/大脑脚的内侧、下丘脑的外侧和中脑的边界，在这个小区域内存在多个结构（3）。包括丘脑底核（subthalamic nucleus，简称丘脑底核）、齿状核和Forel被盖区的核，而穿过该区域的纤维束包括进入丘脑腹侧中间核（ventral intermediate nucleus，简称Vim）的小脑上行束（15）、上升进入丘脑腹尾侧核（ventrocaudal nucleus，简称Vim）的内侧丘系（15）、以及进入丘脑腹侧中间核（ventrocaudal nucleus，简称Vim）的内侧丘系（16）。（Vc，感觉）核，和作为主要纤维输出束的苍白球内（GPi）终止于腹侧运动丘脑（即，Voa，Vop）。然而，与该区域直接相邻的是多个其他结构，其中许多结构在功能上是相互连接的，特别是黑质网状部（SNr）和脚桥核（PPN），它们也在本图中被考虑。
This historical vignette of the region known as “subthalamus” is timely and brings up how our current concepts regarding this region have evolved into the current level of high clinical importance for clinical treatment schemes. This pertinent review of older literature (particularly prior to 1990) highlights how previous concepts as to functioning and treatment in this region have been redefined and improved (1). Whereas most efforts at treatment of this region are now focused on motor disorders (ie, tremor and Parkinson’s disease) this vignette outlines the wide variety of other disorders once considered as involving the subthalamus, including epilepsy (16), chronic pain, and behavioral disorders, as neurosurgeons experimented to define the function of this region. Additionally, the authors include previous treatment paradigms (ie, various forms of lesioning, the previous mainstay of generating a treatment effect), now mostly supplanted by long-term electrical stimulation with deep brain stimulation (DBS), gene therapy approaches to modify long-term cellular function, and other biological or cellular treatments, all focused on augmentation of function rather than lesioning.Defined roughly as the diencephalic region below the AC-PC line (hence ventral to the thalamus), medial to the internal capsule/cerebral peduncle, lateral to the hypothalamus and bordering the mesencephalon, there are multiple structures within this small region (3). Nuclei included are the subthalamic nucleus (STN), zona incerta and nuclei of the tegmental fields of Forel, whereas fiber bundles traversing the region include the ascending cerebellar tracts coursing into the ventral intermediate nucleus (Vim) of the thalamus (15), the medial lemniscus ascending into the ventrocaudal (Vc, sensory) nucleus, and the ansa lenticularis as the main fiber output bundle from globus pallidus interna (GPi) terminating in ventral motor thalamus (ie, Voa, Vop). However, directly bordering this region are multiple additional structures, many of which are functionally connected, particularly substantia nigra pars reticulata (SNr) and pedunculopontine nucleus (PPN), which are also considered in this vignette.