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

Amaç Nükleus kaudatus bazı nörolojik ve psikiyatrik hastalıkların tedavisinde bir hedef olabilir mi diye tartışılmaktadır. Mikrocerrahi girişimler ve stereotaksik yaklaşımlar için kaudat nükleus bağlantılarının daha açık bir şekilde tanımlanması gerekmektedir. Bu çalışmamızda nükleus kaudatus 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 Klingler’ in tekniğine göre -16 °C'de en az 15 gün donduruldu ve birkaç saat boyunca su altında çözülmeleri sağlandı. X6 ila x40 mikroskopik büyütme altında ak madde lif diseksiyonu gerçekleştirildi. Tüm beyin hemisferleri, lateralden mediale doğru kaudat nükleusun başı ve gövdesi ortaya çıkana kadar olarak disseke edildi. Ayrıca, adım adım iki ve üç boyutlu fotoğraflar çekildi. Bulgular Nükleus kaudatus etrafındaki tüm yapılar kademeli olarak 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. Kaudat nükleusa yönelik yapılan derin beyin stimülasyonu klinik pratikte standart bir tedavi yöntemi değildir ama Parkinson hastalığı, obsesif kompülsif hastalık ve majör depresyonda alternatif tedavi olabilir.

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

ObjectiveCaudate nucleus has been discussed as a target fornew treatments of neurologic and psychiatric diseases but the connectivity remains unclear for both microsurgical procedures and stereotactic interventionsdespite the basic neuroanatomical knowledge. Weaim to reveal the anatomic features of the caudatenucleus in psychiatric diseases using fiber dissectiontechnique.Material and MethodsFour brain specimens (8 Hemispheres) were frozen for 15 days at -16 °C according to Klingler’s Technique. The freezing process facilitates the dissectionof the fiber tracts. After completion of the freezing process, all of the hemispheres were dissected and thedissections were stepwise performed from lateral tomedial, under x6 to x40 magnification using a surgicalmicroscope, two and three-dimensional anatomic pictures were obtained.ResultsStepwise microsurgical fiber dissection of the caudate nucleus and adjacent areas were dissected. Thecortical areas communicating with and overlying thecaudate nucleus are reviewed. Frontocaudate connection fibers and temporocaudate fibers were intenseand the microsurgical anatomy of the area were revealed. Two and three dimetional pictures were takenstep by step.ConclusionPsychosurgery has been used primarily in treatmentof depression when medical treatments were notadequate. Deep brain stimulation of caudate nucleusis not a standard method in clinical practice. Deepbrain stimulation of caudate nucleus is not a standardmethod in clinical practice but it could be an alternatetreatment for Parkinson's disease, obsessive compulsive disorder and major depression.

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