The Nucleus Accumbens: A Comprehensive Review

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 deReceived: March 8, 2014 Accepted after revision: September 10, 2014 Published online: February 18, 2015 Michael G. Kaplitt, MD, PhD Department of Neurological Surgery Weill Cornell Medical College 525 East 68th Street, New York, NY 10028 (USA) E-Mail mik2002 @ med.cornell.edu © 2015 S. Karger AG, Basel 1011–6125/15/0932–0075$39.50/0