Targeting the posterior subthalamic area for essential tremor: proposal for MRI-based anatomical landmarks.

Nowacki, Andreas; Debove, Ines; Rossi, Frédéric; Schlaeppi, Janine-Ai; Petermann, Katrin; Wiest, Roland; Schüpbach, Michael; Pollo, Claudio (2018). Targeting the posterior subthalamic area for essential tremor: proposal for MRI-based anatomical landmarks. (In Press). Journal of neurosurgery, pp. 1-8. American Association of Neurological Surgeons 10.3171/2018.4.JNS18373

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OBJECTIVEDeep brain stimulation (DBS) of the posterior subthalamic area (PSA) is an alternative to thalamic DBS for the treatment of essential tremor (ET). The dentato-rubro-thalamic tract (DRTT) has recently been proposed as the anatomical substrate underlying effective stimulation. For clinical purposes, depiction of the DRTT mainly depends on diffusion tensor imaging (DTI)-based tractography, which has some drawbacks. The objective of this study was to present an accurate targeting strategy for DBS of the PSA based on anatomical landmarks visible on MRI and to evaluate clinical effectiveness.METHODSThe authors performed a retrospective cohort study of a prospective series of 11 ET patients undergoing bilateral DBS of the PSA. The subthalamic nucleus and red nucleus served as anatomical landmarks to define the target point within the adjacent PSA on 3-T T2-weighted MRI. Stimulating contact (SC) positions with reference to the midcommissural point were analyzed and projected onto the stereotactic atlas of Morel. Postoperative outcome assessment after 6 and 12 months was based on change in Tremor Rating Scale (TRS) scores.RESULTSActual target position corresponded to the intended target based on anatomical landmarks depicted on MRI. The total TRS score was reduced (improved) from 47.2 ± 15.7 to 21.3 ± 10.7 (p < 0.001). No severe complication occurred. The mean SC position projected onto the PSA at the margin of the cerebellothalamic fascicle and the zona incerta.CONCLUSIONSTargeting of the PSA based on anatomical landmarks representable on MRI is reliable and leads to accurate lead placement as well as good long-term clinical outcome.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Nowacki, Andreas; Debove, Ines; Schlaeppi, Janine-Ai; Petermann, Katrin; Wiest, Roland; Schüpbach, Michael and Pollo, Claudio

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0022-3085

Publisher:

American Association of Neurological Surgeons

Language:

English

Submitter:

Nicole Söll

Date Deposited:

26 Feb 2019 13:37

Last Modified:

26 Feb 2019 13:43

Publisher DOI:

10.3171/2018.4.JNS18373

PubMed ID:

30497206

Uncontrolled Keywords:

AP = anteroposterior DBS DBS = deep brain stimulation DRTT = dentato-rubro-thalamic tract DTI = diffusion tensor imaging ET = essential tremor LAT = lateral MCP = midcommissural point MER = microelectrode recording PSA = posterior subthalamic area ROI = region of interest RaprL = prelemniscal radiation SC = stimulating contact STN = subthalamic nucleus TRS = Tremor Rating Scale VERT = vertical Vim = ventral intermediate nucleus ZI = zona incerta essential tremor fct = cerebellothalamic fascicle functional neurosurgery posterior subthalamic area targeting

BORIS DOI:

10.7892/boris.124556

URI:

https://boris.unibe.ch/id/eprint/124556

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