The Nucleus Accumbens: A Comprehensive Review

Abstract

There is increasing interest among functional neurosurgeons in the potential for novel therapies to impact upon diseases beyond movement disorders and pain. A target of increasing interest is the nucleus accumbens (NAc), which has long been studied as a key brain region mediating a variety of behaviors, including reward and satisfaction. As such, focal modulation of the biology of the NAc with deep brain stimulation or novel biological therapies such as gene therapy or cell transplantation could have a major impact upon disorders such as depression and drug addiction. In order to both develop appropriate therapies and then deliver them in an effective fashion, a thorough understanding of the biology, physiology, and anatomy of the NAc is critical. Here, we review the existing literature regarding several areas critical to the development of new therapies, including the known pharmacology, physiology, and connectivity of the NAc, as well as evidence supporting the potential for various NAc surgical therapies in animal models. We then review the relevant anatomy of the NAc, with particular attention to the surgical anatomy, imaging, and targeting necessary to facilitate a proper localization and delivery of new agents to this region. The NAc is a fascinating and potentially rich target for stereotactic neurosurgical intervention, and analysis of existing information regarding all aspects of this structure should help potentiate therapeutic advances and reduce complications from future studies of neurosurgical intervention in this region for a variety of disorders.

Surgical Anatomy of the Human Nucleus Accumbens: Mavridis' Area and Other Clarifications in Stereotactic Space

“…I read the recent article by Salgado and Kaplitt [1] on the nucleus accumbens (NA) with great interest. They presented a comprehensive review of the anatomical, pharmacological and physiological attributes of the NA, with emphasis on those features most relevant to surgeons who may consider the NA as a target for future therapeutic studies [1].…”

“…They presented a comprehensive review of the anatomical, pharmacological and physiological attributes of the NA, with emphasis on those features most relevant to surgeons who may consider the NA as a target for future therapeutic studies [1]. The purpose of this communication is to clarify some issues regarding the surgical anatomy of the NA presented by these authors.…”

“…At first, I would like to thank Salgado and Kaplitt [1] for mentioning several results of my study regarding the stereotactic and microsurgical NA anatomy [2] in the Surgical Anatomy Section of their review article. However, there are some clarifications and corrections of unintended errors that should be made regarding a few points of their paper.…”

“…First, the authors mentioned that ‘in coronal sections 2 mm anterior to the anterior commissure (AC), the NA was found 6-9 mm anterior to the rostral border of the AC and 1-2 mm inferior to the AC regardless of hemisphere' [1]. It is correct that the NA is always found 6-9 mm lateral to the midline and from 1 mm superior to 2 mm inferior to the AC regardless of the hemisphere (area G) [2].…”

Single dose ketamine injection affects activation of cells in the nucleus accumbens of prenatally stressed rats

“…[9][10][11][12] As a major component of the ventral striatum, NAc extends dorsolaterally into the putamen and dorsomedially into the caudate nucleus. [13] The NAc contains a large number of γ-aminobutyric acid (GABA)-containing medium spiny projecting neurons (%95) and only a small populations of GABAergic and cholinergic interneurons. [14] The activity of medium spiny neurons is regulated by glutamatergic afferents coming from the prefrontal cortex, hippocampus and amygdala, dopaminergic Single dose ketamine injection affects activation of cells in the nucleus accumbens of prenatally stressed rats Elif Polat Çorumlu 1 afferents from the ventral tegmental area, as well as serotonergic and noradrenergic afferents from the raphe nucleus, and the locus ceruleus, respectively.…”