Stereotactic anatomy of the human nucleus accumbens: from applied mathematics to microsurgical accuracy

Stereotactic surgery of the human NA is a neurosurgical achievement of the twenty-first century. Our purpose was to provide a clinically oriented study focused on the detailed stereotactic anatomy of the NA, with great respect to its targeting. We tried to offer a guide of NA stereotactic targeting for neurosurgeons.

For our imaging study, we used cerebral magnetic resonance images (MRIs) from 26 neurosurgical patients (52 NAs). The material of our anatomic study consisted of 32 cerebral hemispheres (32 NAs) from 18 normal human brains, which we have in our Department (Department of Anatomy) from cadaver donors. We measured and analyzed the X, X', Y, Y', Z, Z' stereotactic coordinates of the NA at specific clinically important transverse, coronal and sagittal levels.

Our principal findings contain a probability-based guide for in vivo (side depended) stereotactic localization of the human NA, a standard for the NA, specific stereotactic zone of the human brain (Z = -4), two specific standard NA areas (X = 7, X = 8) and the most reliable stereotactically standard area of the human NA (Y = 2).

We provide a stereotactic anatomic guide for some common targeting necessities of the NA stereotactic surgery, resulted from detailed analysis and careful combination of the measured data of our clinically oriented study. We hope that our work will be a really useful guide for neurosurgeons applying deep brain stimulation of the NA.