KAUDAT NUKLEUS BAĞLANTI YOLLARI MİKROCERRAHİ ANATOMİSİ’NİN PSİKOŞİRÜRJİKAL ÖNEMİ: ÖZGÜN KADAVRA ARAŞTIRMA ÇALIŞMASI

Öz

Amaç: Kaudat Nukleus bazı nörolojik ve psikiyatrik hastalıkların tedavisinde bir hedef olabilir mi diye tartışılmaktadır. Mikrocerrahi girişimler ve stereotaksik yaklaşımlar için Kaudat Nukleus bağlantılarının daha açık bir şekilde tanımlanması gerekmektedir. Bu çalışmamızda  Kaudat Nucleus mikrocerrahi anatomisini ve bağlantı yollarını  fiber diseksiyon tekniği kullanarak ortaya koymayı ve bunun psikoşirürjikal önemini orrtaya koymayı  amaçladık.

Gereç ve Yöntem: Dört adet formalinle fikse edilmiş insan beyni (8 hemisfer) detaylı şekilde incelendi. Tüm örnekler -16 ° C 'de en az 15 gün donduruldu ve birkaç saat boyunca su altında çözülmeleri sağlandı. Zeiss marka cerrahi  mikroskobu ile x6 ila x40 büyütme altında mikro ayıraçlar kullanılarak ak madde lif diseksiyonu gerçekleştirildi. Sekiz beyin hemisferi, medial serebral yüzeyden başlayarak ve kaudat çekirdeğin başı ve gövdesi ortaya çıkana kadar lateral olarak disseke edildi. Diseksiyonların tüm aşamaları, Canon T5 Rebel dijital kamera ile kaydedildi.

Bulgular: Kaudat nukleus etrafındaki tüm yapılar adım adım diseke edildi. Bu yapı ile iletişim halinde olan ve fiziksel olarak temas eden tüm kortikal alanlar gözden geçirildi. Frontokaudat ve frontotemporal bağlantıların mikrocerrahi anatomisi ayrıntılı ortaya konuldu.

Sonuç: Psikoşirürji, medikal tedavilerin henüz gelişmediği dönemlerde, depresyon tedavisinde öncelikli olarak kullanılmıştır. Medikal tedavinin geliştiği çağda psikoşirürjinin duraklama dönemine girdiği, ancak günümüzde nöromodülasyon teknolojisinin de gelişmesiyle birlikte, tekrar öneminin artacağı görülmektedir. Derin beyin stimülasyonu uygulamasının Kaudat Nukleus için rutin bir klinik uygulaması bulunmamaktadır. Kaudat Nucleus ve bağlantı yollarının Derin Beyin Stimulasyonunun, parkinson hastalığı obsesif kompulsif bozukluk ve major depresyon gibi hastalıklarda alternatif bir hedef bölge olarak caudat nukleusun   kullanılabileceği  düşünülmektedir.

Anahtar Kelimeler

• Kaudat,Nukleus,Psikoşirurji,Anatomi

MICROSURGICAL ANATOMY OF THE CONNECTIONS OF CAUDATE NUCLEUS AND PSYCHOSURGICAL CONSIDERATIONS : A UNIQUE CADAVER STUDY

Öz

Aim: Caudate Nucleus has been discussed as a target for new treatments of neurologic and psychiatric diseases but the connectivity remains unclear for both microsurgical procedures and stereotactic interventions despite the basic neuroanatomical knowledge. We aim to reveal the anatomic relationship of the caudate nucleus using fiber dissection technique.

Material and Methods: Four brain specimens (8 Hemispheres) were frozen for 15 days at -16 °C according to Klingler’s Technique. The freezing process facilitates the dissection of the fiber tracts. After completion of the freezing process, the dissections were stepwise performed from lateral to medial, under x6 to x40 magnification using a surgical microscope, two and three-dimensional anatomic pictures were obtained.

Results: Stepwise microsurgical fiber dissection of the Caudate Nucleus and adjacent areas were dissected. The cortical areas communicating with and overlying the Caudate Nucleus are reviewed. Frontocaudate Connection Fibers and Temporocaudate Fibers were intense and the microsurgical anatomy of the area were revealed.

Conclusion: Psychosurgery has been used primarily in the treatment of depression when the medical treatments were not adequate. Deep Brain Stimulation of Nucleus Caudatus is not standard treatment procedure in the clinical practice. It may be considered that  different parts of the Caudate Nucleus and connection fibers associated with Caudate Nucleus can be used as a target for Deep Brain Stimulation which could be an alternative treatment for Parkinson's Disease, Obsessive Compulsive Disorder and Major Depression.

Anahtar Kelimeler

• Caudate,Nucleus,Psychosurgery,Anatomy,Connection

Destekleyen Kurum

University of Florida Mc Knight Brain Institute Department of Neurosurgery , Microneurosurgical Anatomy Laboratory

Teşekkür

We are gratefull for Prof.Dr. Albert Rhoton (RIP) for his world class mentoship.

Kaynakça

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