Individualized Anatomy-Based Targeting for VIM-cZI DBS in Essential Tremor.
Aged
Deep Brain Stimulation
/ methods
Essential Tremor
/ surgery
Female
Humans
Image Interpretation, Computer-Assisted
/ methods
Imaging, Three-Dimensional
/ methods
Magnetic Resonance Imaging
Male
Middle Aged
Neuronavigation
/ methods
Retrospective Studies
Subthalamic Nucleus
/ surgery
Surgery, Computer-Assisted
/ methods
Zona Incerta
/ surgery
DBS
Essential tremor
Ventral intermediate
Zona incerta
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
03
04
2020
revised:
29
04
2020
accepted:
30
04
2020
pubmed:
22
5
2020
medline:
18
12
2020
entrez:
22
5
2020
Statut:
ppublish
Résumé
Deep brain stimulation of the ventral intermediate nucleus (VIM) or caudal zona incerta (cZI) is effective for refractory essential tremor (ET). To refine stereotactic planning for lead placement, we developed a unique individualized anatomy-based planning protocol that targets both the VIM and the cZI in patients with ET. 33 patients with ET underwent VIM-cZI lead implantation with targeting based on our protocol. Indirect targeting was adjusted based on anatomic landmarks as reference lines bisecting the red nuclei and ipsilateral subthalamus. Outcomes were evaluated through the follow-up of 31.1 ± 18.4 months. Active contact coordinates were obtained from reconstructed electrodes in the Montreal Neurological Institute space using the MATLAB Lead-DBS toolbox. Mean tremor improvement was 79.7% ± 22.4% and remained stable throughout the follow-up period. Active contacts at last postoperative visit had mean Montreal Neurological Institute coordinates of 15.5 ± 1.6 mm lateral to the intercommissural line, 15.3 ± 1.8 mm posterior to the anterior commissure, and 1.4 ± 2.9 mm below the intercommissural plane. No hemorrhagic complications were observed in the analyzed group. Individualized anatomy-based VIM-cZI targeting is feasible and safe and is associated with favorable tremor outcomes.
Sections du résumé
BACKGROUND
Deep brain stimulation of the ventral intermediate nucleus (VIM) or caudal zona incerta (cZI) is effective for refractory essential tremor (ET). To refine stereotactic planning for lead placement, we developed a unique individualized anatomy-based planning protocol that targets both the VIM and the cZI in patients with ET.
METHODS
33 patients with ET underwent VIM-cZI lead implantation with targeting based on our protocol. Indirect targeting was adjusted based on anatomic landmarks as reference lines bisecting the red nuclei and ipsilateral subthalamus. Outcomes were evaluated through the follow-up of 31.1 ± 18.4 months. Active contact coordinates were obtained from reconstructed electrodes in the Montreal Neurological Institute space using the MATLAB Lead-DBS toolbox.
RESULTS
Mean tremor improvement was 79.7% ± 22.4% and remained stable throughout the follow-up period. Active contacts at last postoperative visit had mean Montreal Neurological Institute coordinates of 15.5 ± 1.6 mm lateral to the intercommissural line, 15.3 ± 1.8 mm posterior to the anterior commissure, and 1.4 ± 2.9 mm below the intercommissural plane. No hemorrhagic complications were observed in the analyzed group.
CONCLUSIONS
Individualized anatomy-based VIM-cZI targeting is feasible and safe and is associated with favorable tremor outcomes.
Identifiants
pubmed: 32438003
pii: S1878-8750(20)30954-2
doi: 10.1016/j.wneu.2020.04.240
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e225-e233Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.