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DBS Phase 1 > Neuroanatomy > Flashcards

Neuroanatomy Flashcards

1
Q

What is typical entry point?

A

traverses gyri SMA (supplementary motor area)

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2
Q

What is the outer part of the brain called?

A

cortex, cortical surface of the brain

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3
Q

What do you want to avoid when entering the brain?

A

primary motor cortex, ventricles and sulci

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4
Q

What are sulci?

A

valleys, very vascular, not good to enter here

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5
Q

What are gyri?

A

mountains/hills, good place to enter because less risky

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6
Q

What is the coronal suture?

A

Where 2 plates come together, dip in skull, make burr hole here, keeps you close to SMA and away from primary motor cortex

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7
Q

What is AC?

A

anterior commisure, runs across, looks like handle bars

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8
Q

What are commisures?

A

good guides and reference points because everyone has them, similar from person to person, easy to get to functional targets, white matter fiber bundles, crossing from L to R hemisphere of the brain

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9
Q

What is PC?

A

posterior commisure

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10
Q 
The distal contact is the most \_\_\_ in the brain?
posterior
anterior
dorsal
ventral
A

ventral

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11
Q

What is the pineal gland?

A

sits above the PC, good landmark

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12
Q

What areas are involved in typical trajectory?

A 
cortex
striatum (Caudate) or internal capsule
thalamus
Zona Inserta or Fields of Forel (grey matter)
STN
SNr
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13
Q

What part of the STN is typically best to stimulate?

A

motor, dorsal and lateral

dorsolateral

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14
Q

What is a typical DBS lead trajectory?

A

pre-coronal entry point passes through the prefrontal cortex, subcortical white matter, the anterior limb of the internal capsule and the basal ganglia

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15
Q

What are the divisions of the STN? Why is this important?

A

Emotional/Limbic
Motor/Movement
Cognitive
We don’t just want to blow up the STN with energy, we generally want to be in the motor part of STN, the dorsal lateral portion, this is why we do MER

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16
Q

What is the anterior division of the STN responsible for?

A

emotional

17
Q

What is the dorsal lateral division of the STN responsible for?

A

motor/movement (largest)

18
Q

What is the medial part of the STN responsible for?

A

cognitive (associative)

19
Q

What is halfway between the AC and PC?

A

Mid commisural (MC)

20
Q

What are the typical coordinate for STN from MC?

A

Lateral: 12mm
Inferior: 3mm center of motor (STN), 4-5mm bottom of nucleus
Posterior: 3mm

21
Q

What 2 parts of the brain make up the striatum? How do you describe what they look like?

A

Caudate and Putamen, caudate looks like a snake and the putamen looks like an egg that the caudate wraps around

22
Q

What is the lemon wedge shape of matter above the pallidus?

A

Putamen

23
Q

What lies lateral to the STN? (dark matter)

A

posterior limb of internal capsule (IC)

24
Q

What lies on the other side lateral to the Internal Capsule? (STN on one side, what’s on the other)

A

globus pallidus

25
Q

What separates the lobes of the brain?

A

fissures

26
Q

what are the 4 lobes of the brain?

A

frontal, parietal, occipital, temporal

27
Q

Which lobe is associated with reasoning, motor skills, and expressive language?

A

frontal

28
Q

T/F Substantia Nigra is a main target for DBS Surgery.

A

F

29
Q

Which lobe do surgeons generally attempt to pass the lead through?

A

frontal lobe

30
Q

Explain the direct vs indirect pathway.

A

Direct Pathway: cortex-striatum-thalamus
overall effect: facilitates movement

Indirect Pathway: cortex-striatum-GPe-STN-GPi-thalamus
overall effect: inhibits movement

31
Q

What is the trajectory once the physician is in the STN?

A

Thalamus: 20mm TO START
Zona Inserta: 8mm
STN: 4-5mm (or higher)
SNr: 1mm below target

32
Q

What is STN target for DBS?

A

dorsal and lateral

33
Q

What are the indirect coordinates for targeting the GPI?

A

We are targeting the lateral, inferior border (medial would be the internal capsule)
Lateral: 17.5mm from the wall of the 3rd ventricle
Anterior: 2mm from MC
Inferior: 5mm from MC

34
Q

What are the indirect coordinates for targeting ViM

A

Lateral: 11.5mm
Posterior: 2 1/2 - 3 1/2 mm fraction of the AC/PC line length
Anterior: to the PC

35
Q

What is ring mode and why is this important?

A

single source, when using more than 1 contact, is not voltage controlled or current controlled, it is impedance controlled, MICC is true ring mode because you can control energy circumferentially`

36
Q

What are the components of the Basil Ganglia?

A

Caudate: striatum and putamen
Globus Pallidus: GPe and GPi
Subthalamic Nucleus: STN
Substantial Nigra: SNr

37
Q

What is a neuron?

A

cells that transmit information: sensory, motor and interneurons, in general motor neurons control the symptoms associated with PD

38
Q

Explain neuron communication

A
  • dendrites collect electrical signals, receivers
  • cell body integrates incoming signals and generates outgoing signal to axon
  • axon: passes electrical signals to dendrites of another cell (transmitters)
39
Q

What are the four distinct phases of an action potential?

A

resting sate: neuron is not sending signals and inside of the cell has a negative charge
depolarizing state: a stimulus causes the sodium channels to open, the negatively charged neuron causes positive sodium ions to rush in, the inside of the neuron becomes momentarily positively charged and its said to be depolarized
repolarizing state: the depolarization of the neuron leads to the opening of the potassium channels, allowing positive ions to leave the cell, the cell is back in the negative range
undershoot: refractory period since it is the very short period when another action potential is not possible

DBS Phase 1 (6 decks)

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