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Fontana HJ, Mazzucco J, Lescano S. The anterior perforated substance (APS) revisited: Commented anatomical and imagenological views. Brain Behav 2023; 13:e3029. [PMID: 38010896 PMCID: PMC10726791 DOI: 10.1002/brb3.3029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/10/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Since 2002, when we published our article about the anterior perforated substance (APS), the knowledge about the region has grown enormously. OBJECTIVE To make a better description of the anatomy of the zone with new dissection material added to the previous, to sustain the anatomical analysis of the MRI employing the SPACE sequence, interacting with our imagenology colleagues. Especially, we aim to identify and topographically localize by MRI the principal structures in APS-substantia innominata (SI). METHOD The presentation follows various steps: (1) location and boundaries of the zone and its neighboring areas; (2) schematic description of the region with simple outlines; (3) cursory revision of the SI and its three systems; (4) serial images of the dissections of the zone and its vessels, illustrated and completed when possible, by MRI images of a voluntary experimental subject (ES). RESULTS With this method, we could expose most of the structures of the region anatomically and imagenologically. DISCUSSION The zone can be approached for dissection with magnification and the habitual microsurgical instruments with satisfactory results. We think that fibers in this region should be followed by other anatomical methods in addition to tractography. The principal structures of ventral striopallidum and extended amygdala (EA) can be identified with the SPACE sequence. The amygdala and the basal ganglion of Meynert (BGM) are easily confused because of their similar signal. Anatomical clues can orient the clinician about the different clusters of the BGM in MRI. CONCLUSIONS The dissection requires a previous knowledge of the zone and a good amount of patience. The APS is a little space where concentrate essential vessels for the telencephalon, "en passage" or perforating, and neural structures of relevant functional import. From anatomical and MRI points of view, both neural and vascular structures follow a harmonious and topographically describable plan. The SPACE MRI sequence has proved to be a useful tool for identifying different structures in this area as the striatopallidal and EA. Anatomical knowledge of the fibers helps in the search of clusters of the basal ganglion.
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Affiliation(s)
| | - Juan Mazzucco
- Instituto ARGUS de Diagnóstico por ImágenesBuenos AiresArgentina
| | - Sebastián Lescano
- ARGUS Diagnóstico por Imágenes CNS imagenologistBuenos AiresArgentina
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Coenen VA, Schlaepfer TE, Sajonz BEA, Reinacher PC, Döbrössy MD, Reisert M. “The Heart Asks Pleasure First”—Conceptualizing Psychiatric Diseases as MAINTENANCE Network Dysfunctions through Insights from slMFB DBS in Depression and Obsessive–Compulsive Disorder. Brain Sci 2022; 12:brainsci12040438. [PMID: 35447971 PMCID: PMC9028695 DOI: 10.3390/brainsci12040438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 02/04/2023] Open
Abstract
More than a decade ago, deep brain stimulation (DBS) of the superolateral medial forebrain bundle (slMFB), as part of the greater MFB system, had been proposed as a putative yet experimental treatment strategy for therapy refractory depression (TRD) and later for obsessive–compulsive disorders (OCD). Antidepressant and anti-OCD efficacy have been shown in open case series and smaller trials and were independently replicated. The MFB is anato-physiologically confluent with the SEEKING system promoting euphoric drive, reward anticipation and reward; functions realized through the mesocorticolimbic dopaminergic system. Growing clinical experience concerning surgical and stimulation aspects from a larger number of patients shows an MFB functionality beyond SEEKING and now re-informs the scientific rationale concerning the MFB’s (patho-) physiology. In this white paper, we combine observations from more than 75 cases of slMFB DBS. We integrate these observations with a selected literature review to provide a new neuroethological view on the MFB. We here formulate a re-interpretation of the MFB as the main structure of an integrated SEEKING/MAINTENANCE circuitry, allowing for individual homeostasis and well-being through emotional arousal, basic and higher affect valence, bodily reactions, motor programing, vigor and flexible behavior, as the basis for the antidepressant and anti-OCD efficacy.
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Affiliation(s)
- Volker A. Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany; (B.E.A.S.); (P.C.R.); (M.D.D.); (M.R.)
- Medical Faculty, Freiburg University, 79106 Freiburg, Germany;
- Center for Deep Brain Stimulation, Medical Center of Freiburg University, 79106 Freiburg, Germany
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional, Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany
- Correspondence: ; Tel.: +49-761-270-50630; Fax: +49-761-270-50100
| | - Thomas E. Schlaepfer
- Medical Faculty, Freiburg University, 79106 Freiburg, Germany;
- Center for Deep Brain Stimulation, Medical Center of Freiburg University, 79106 Freiburg, Germany
- Department of Interventional Biological Psychiatry, Medical Center of University of Freiburg, 79106 Freiburg, Germany
| | - Bastian E. A. Sajonz
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany; (B.E.A.S.); (P.C.R.); (M.D.D.); (M.R.)
- Medical Faculty, Freiburg University, 79106 Freiburg, Germany;
| | - Peter C. Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany; (B.E.A.S.); (P.C.R.); (M.D.D.); (M.R.)
- Medical Faculty, Freiburg University, 79106 Freiburg, Germany;
- Fraunhofer Institute for Laser Technology (ILT), 52074 Aachen, Germany
| | - Máté D. Döbrössy
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany; (B.E.A.S.); (P.C.R.); (M.D.D.); (M.R.)
- Medical Faculty, Freiburg University, 79106 Freiburg, Germany;
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional, Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany
- Faculty of Biology, University of Freiburg, 79104 Freiburg, Germany
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany; (B.E.A.S.); (P.C.R.); (M.D.D.); (M.R.)
- Medical Faculty, Freiburg University, 79106 Freiburg, Germany;
- Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center of University of Freiburg, 79106 Freiburg, Germany
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