Anatomska podjela subtalamičke jezgre [Anatomical subdivison of the subthalamic nucleus]

Almahariq, Fadi (2020) Anatomska podjela subtalamičke jezgre [Anatomical subdivison of the subthalamic nucleus]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Subthalamic nucleus is one of the most interesting structures of basal ganglia. Neurosurgical stimulation of STN has improved condition of many patients with levodopa resistant Parkinson’s disease. However, it also led to many unwanted side-effects due to the inconclusive delineation of STN segments’ borders. Previous studies which dealt with this topic did not produce definite answer about number and location of STN segments. In this study we analyzed the distribution of five neuronal markers in the STN: NeuN, calretinin, calbindin, parvalbumin and nNOS. All markers were positive in STN except calbindin. The largest population of neurons in STN is positive for nNOS, and the smallest population is calretinin positive. By analyzing the spatial distribution of neurons in STN we could not determine the borders between segments nor any individual segments in STN. Furthermore, we analyzed 1,5 and 3T MR images to determine STN segments. We were not able to determine any segments on these images. However, we analyzed the precision of DBS electrode location in the STN and based on these data we created “virtual” motor segment of STN. The stimulation within these “virtual segment” provided satisfactory clinical results in controlling symptoms of Parkinson’s disease.

Abstract in Croatian

Subtalamička jezgra je trenutno jedna od klinički najzanimljivijih struktura bazalnih ganglija. Neurokirurško stimuliranje subtalamičke jezgre pomoglo je mnogim bolesnicima s Parkinsonovom bolesti otpornom na levodopu, no dovelo je i do neželjenih nuspojava zbog nejasnih granica segmenata STN. Studije koje su se bavile podjelom STN nisu dale jasan odgovor oko broja i mjesta smještaja segmenata. U ovoj studiji analizirali smo raspodjelu četiri markera neurona: NeuN, kalbindin, kalretinin, parvalbumin i nNOS. Osim kalbindina svih drugi markeri su pozitivni u STN. Najveći broj neurona pozitivan je na nNOS, dok najmanji broj neurona je pozitivan na kalretinin. Analizirajući prostornu distribuciju ovih subklasa nije moguće utvrditi jasne granice između segmenata niti podijeliti STN u zasebne segmente. Također, analize MR snimaka na 1.5 i 3T uređajima nije bilo moguće utvrditi segmente u STN. Analiza preciznosti postavljanja DBS elektrode u STN omogućila nam je stvaranje „virtualnog“ motoričkog segmenta STN te je stimulacija tog dijela STN dovela do zadovoljavajućih kliničkih rezultata liječenja Parkinsonove bolesti.

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