Validation of targeting the ventrointermediate thalamic nucleus using Q-ball calculation in deep brain stimulation for tremor

Stieglitz, Lennart H.; Oertel, Markus F.; Lönnfors-Weitzel, Tarja; Kiefer, Claus; Schüpbach, Michael; Kaelin-Lang, Alain; Raabe, Andreas; Pollo, Claudio (May 2013). Validation of targeting the ventrointermediate thalamic nucleus using Q-ball calculation in deep brain stimulation for tremor. In: 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). German Medical Science GMS Publishing House 10.3205/13dgnc303

Objective: Identification of the ventrointermediate thalamic nucleus (Vim) in modern 3T high-field MRI for image-based targeting in deep brain stimulation (DBS) is still challenging. To evaluate the usefulness and reliability of analyzing the connectivity with the cerebellum using Q-ball-calculation we performed a retrospective analysis. Method: 5 patients who underwent bilateral implantation of electrodes in the Vim for treatment of Essential Tremor between 2011 and 2012 received additional preoperative Q-ball imaging. Targeting was performed according to atlas coordinates and standard MRI. Additionally we performed a retrospective identification of the Vim by analyzing the connectivity of the thalamus with the dentate nucleus. The exact position of the active stimulation contact in the postoperative CT was correlated with the Vim as it was identified by Q-ball calculation. Results: Localization of the Vim by analysis of the connectivity between thalamus and cerebellum was successful in all 5 patients on both sides. The average position of the active contacts was 14.6 mm (SD 1.24) lateral, 5.37 mm (SD 0.094 posterior and 2.21 mm (SD 0.69) cranial of MC. The cranial portion of the dentato-rubro-thalamic tract was localized an average of 3.38 mm (SD 1.57) lateral and 1.5 mm (SD 1.22) posterior of the active contact. Conclusions: Connectivity analysis by Q-ball calculation provided direct visualization of the Vim in all cases. Our preliminary results suggest, that the target determined by connectivity analysis is valid and could possibly be used in addition to or even instead of atlas based targeting. Larger prospective calculations are needed to determine the robustness of this method in providing refined information useful for neurosurgical treatment of tremor.

Item Type:

Conference or Workshop Item (Abstract)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
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

UniBE Contributor:

Stieglitz, Lennart; Oertel, Markus Florian; Lönnfors-Weitzel, Tarja; Kiefer, Claus; Schüpbach, Michael; Kaelin, Alain; Raabe, Andreas and Pollo, Claudio

Subjects:

600 Technology > 610 Medicine & health

Publisher:

German Medical Science GMS Publishing House

Language:

English

Submitter:

Nicole Söll

Date Deposited:

03 Apr 2014 10:59

Last Modified:

03 Apr 2014 10:59

Publisher DOI:

10.3205/13dgnc303

URI:

https://boris.unibe.ch/id/eprint/44604

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