Subthalamic or red nucleus? A puzzling question arising during intraoperative recording for DBS 1).
The red nucleus or nucleus ruber is a structure in the rostral midbrain involved in motor coordination. It is pale pink in color; the color is believed to be due to iron, which is present in the red nucleus in at least two different forms: hemoglobin and ferritin.
It comprises a caudal magnocellular and a rostral parvocellular part. It is located in the tegmentum of the midbrain next to the substantia nigra. The red nucleus and substantia nigra are subcortical centers of the extrapyramidal motor system.
The dentatorubrothalamic tract (DRTT) is the major efferent cerebellar pathway arising from the dentate nucleus (DN) and decussating to the contralateral red nucleus (RN) and thalamus. Surprisingly, hemispheric cerebellar output influences bilateral limb movements. In animals, uncrossed projections from the DN to the ipsilateral RN and thalamus may explain this phenomenon.
The red nucleus is a important centre for the genesis of cerebellar tremor and thus a possible target for drug-refractory tremor. Future research must determine how neuromodulation of the red nucleus can best be implemented in patients with cerebellar degeneration 2).