Neurophysiological Atlas of the Human Thalamus and Adjacent Structures

Yoshida, Masafumi; Okada, Kazuhiro; Nagase, Akihiro; Kuga, Shigeki; Shirahama, Masahiro; Watanabe, Mituso; Kuramoto, Shinken

doi:10.1159/000101633

Cited by 4 publications

(5 citation statements)

References 5 publications

(7 reference statements)

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“…Lesional PSA surgery is known to be effective for tremors in general and has been used in many rare tremor cases [14]. Open studies and two recent randomized blinded trials have suggested that DBS of the cZI/PSA is superior to VIM DBS in terms of tremor relief and current efficiency [4,24,43,45,62,63]. For rare tremor syndromes, the number of reports is very limited [5].…”

Section: Discussionmentioning

confidence: 99%

“…A horizontal line was drawn passing through the equator of the red nucleus at the level of its maximum diameter. The target point in the PSA was defined on this line, 2/3 of the distance from the lateral border of the red nucleus toward the posterior tip of the subthalamic nucleus [44][45][46][47][48][49]. The VIM target was calculated as the sum of the targets used by Watanabe et al [45], Mink et al [49], Benabid et al [43], and Ferreira et al [48].…”

Section: Preoperative Planning and Surgical Techniquementioning

confidence: 99%

“…The target point in the PSA was defined on this line, 2/3 of the distance from the lateral border of the red nucleus toward the posterior tip of the subthalamic nucleus [44][45][46][47][48][49]. The VIM target was calculated as the sum of the targets used by Watanabe et al [45], Mink et al [49], Benabid et al [43], and Ferreira et al [48]. These all consider the width of the third ventricle and the AC-PC line distance [46,47,50,51].…”

Section: Preoperative Planning and Surgical Techniquementioning

confidence: 99%

“…These all consider the width of the third ventricle and the AC-PC line distance [46,47,50,51]. The approximate target is at the junction of the posterior 1/4 and 2/4 of the AC-PC line, 10-11 mm lateral to the ventricular wall at the depth of the MCP [45][46][47][48][49]. The electrode's trajectory was then adjusted in the coronal and sagittal planes to align with the VIM target such that the deepest contact would be at the target point in the PSA, while the third and/or fourth contact would reach the VIM (Fig.…”

Section: Preoperative Planning and Surgical Techniquementioning

confidence: 99%

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Deep Brain Stimulation with Double Targeting of the VIM and PSA for the Treatment of Rare Tremor Syndromes

Yilmaz,

Eray,

Cakir

et al. 2024

Stereotact Funct Neurosurg

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Introduction: In tremor syndromes, pharmacological therapy is the primary treatment, but deep brain stimulation (DBS) is used when it is insufficient. We explore the use of DBS, focusing on the globus pallidus internus for dystonia and the ventral intermediate nucleus (VIM) for tremor conditions. We introduce the posterior subthalamic area (PSA) as a potential target, suggesting its efficacy in tremor reduction, particularly in rare tremor syndromes. We aim to evaluate the efficacy and safety of double targeting the VIM and PSA in rare tremor conditions, highlighting the limited existing data on this. Methods: Between 2019 and 2023, 22 patients with rare tremor syndromes were treated with bilateral DBS of the VIM and PSA. This case series consisted of 7 isolated head tremor, 1 hepatic encephalopathic tremor due to Abernethy syndrome, 2 voice tremor, 4 dystonic tremor, and 8 Holmes tremor (2 multiple sclerosis, 2 cerebellar insult, and 4 posttraumatic) patients. Patients’ preoperative and 12-month postoperative tremor scores were compared, and the optimum VIM and PSA stimulation areas were investigated. Results: There was a significant reduction in the mean TRS score from 3.70 (±0.57) to 0.45 (±0.68) after 12 months of surgery. Specific outcomes for different indications were observed: for head tremor, 6 of 7 patients showed a reduction in TRS scores to 0 points; the vocal tremor patients demonstrated improvement; this change was not statistically significant, which is likely to be due to the low number of patients in this subgroup; the dystonic tremor patients showed either complete tremor abolition or a reduction in TRS scores; the Holmes tremor patients showed an 80% reduction in TRS scores; and the hepatic encephalopathy tremor and Abernethy syndrome patients showed a 75% improvement in TRS scores. The stimulation parameters converged on the VIM and dorsal PSA. Complications included the need for electrode repositioning, infections requiring electrode removal and re-implantation, dysarthria, and stimulation-induced ataxia, which was resolved by adjusting the stimulation parameters. Discussion: The literature on DBS for rare tremors is limited. Double targeting of the VIM and PSA appears to produce promising improvements on the outcomes reported in the existing literature on VIM-only DBS. The proximity of the VIM and PSA allows for flexible electrode placement, contributing to the potential success of the dual-target approach. We also discuss the theoretical advantages of targeting the PSA based on the distribution of tremor circuits, emphasizing the need for further research and electrophysiological studies.

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Section: Discussionmentioning

confidence: 99%

Section: Preoperative Planning and Surgical Techniquementioning

confidence: 99%

Section: Preoperative Planning and Surgical Techniquementioning

confidence: 99%

Section: Preoperative Planning and Surgical Techniquementioning

confidence: 99%

See 2 more Smart Citations

Deep Brain Stimulation with Double Targeting of the VIM and PSA for the Treatment of Rare Tremor Syndromes

Yilmaz,

Eray,

Cakir

et al. 2024

Stereotact Funct Neurosurg

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show abstract

“…To improve the accuracy of surgical targeting, various researchers have collected and analyzed functional data from subcortical structures of multiple individuals during stereotaxy [59][60][61][62]. The data were transformed into alphanumeric codes to standardize the electrophysiological data, which were then normalized to an anatomical atlas to create composite functional maps.…”

Section: Probabilistic and Functional Atlasesmentioning

confidence: 99%

A Brief History of Stereotactic Atlases: Their Evolution and Importance in Stereotactic Neurosurgery

Conti,

Gambadauro,

Mantovani

et al. 2023

Brain Sciences

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Following the recent acquisition of unprecedented anatomical details through state-of-the-art neuroimaging, stereotactic procedures such as microelectrode recording (MER) or deep brain stimulation (DBS) can now rely on direct and accurately individualized topographic targeting. Nevertheless, both modern brain atlases derived from appropriate histological techniques involving post-mortem studies of human brain tissue and the methods based on neuroimaging and functional information represent a valuable tool to avoid targeting errors due to imaging artifacts or insufficient anatomical details. Hence, they have thus far been considered a reference guide for functional neurosurgical procedures by neuroscientists and neurosurgeons. In fact, brain atlases, ranging from the ones based on histology and histochemistry to the probabilistic ones grounded on data derived from large clinical databases, are the result of a long and inspiring journey made possible thanks to genial intuitions of great minds in the field of neurosurgery and to the technical advancement of neuroimaging and computational science. The aim of this text is to review the principal characteristics highlighting the milestones of their evolution.

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Electrophysiology-guided deep brain neurosurgery

Peters

2005

2005 IEEE Engineering in Medicine and Biology 27th Annual Conference

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Since the discovery of X-rays, medical imaging has played a major role in the guidance of surgical procedures. Recent advances in computer technology have only accelerated the rapid development of this field. As interventions become significantly less invasive, the use of pre-operative and intra-operative images to guide surgery has assumed increasing importance. Image-guided techniques have been employed for many years to plan and guide neurosurgical procedures. Amongst the most challenging areas of neurosurgery is the accurate targeting of nuclei within the deep brain for the treatment of Parkinson's and other motor system diseases. Unfortunately, standard CT and MR imaging does not permit the anatomical delineation of the targets, and so additional information, for example atlases and electrophysiological data, must also be employed. Both these forms of data can be mapped, using non rigid image registration techniques, to a standard representation of a brain acquired from MRI. The electrophysiology database can also evolve over time with the incorporation of data acquired from multiple patients operated in the past. Information of this nature can then be incorporated within the patient image, and serve as an invaluable tool in predicting to the surgeon the likely area of the target. This approach can significantly reduce the trauma associated with the insertion of multiple unnecessary electrodes to refine the target location, and speed up the procedure.

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Neurophysiological Atlas of the Human Thalamus and Adjacent Structures

Cited by 4 publications

References 5 publications

Deep Brain Stimulation with Double Targeting of the VIM and PSA for the Treatment of Rare Tremor Syndromes

Deep Brain Stimulation with Double Targeting of the VIM and PSA for the Treatment of Rare Tremor Syndromes

A Brief History of Stereotactic Atlases: Their Evolution and Importance in Stereotactic Neurosurgery

Electrophysiology-guided deep brain neurosurgery

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