Highlights
- •We demonstrate a new method for identifying deep brain stimulation trajectory.
- •Our method employs a combination of high-resolution MRI and fiber tractography.
- •Motor scores improved at 6-month and last follow-up.
Abstract
Objectives
Deep brain stimulation (DBS) of the ventral intermediate (Vim) thalamic nucleus is
used to treat tremors. Here, we identified the Vim nucleus on fast gray matter acquisition
T1 inversion recovery (FGATIR) images and delineated the dentate-rubrothalamic tract
(DRT) to determine the DBS target. We evaluated whether this method could consistently
identify the Vim nucleus by anatomical imaging and fiber tractography.
Methods
We retrospectively reviewed clinical data of patients who underwent unilateral thalamic
DBS for severe tremor disorders. We evaluated outcomes at baseline, 6 months and 1 year
following intervention, and annually thereafter. We reviewed preoperative planning
to determine whether our tractography technique could consistently depict the DRT,
and evaluated implanted electrode position by fusing postoperative CT scans to preoperative
MR images.
Results
Seven patients (three men and four women) were included; preoperative diagnoses included
essential tremor (n = 3), Parkinson's (n = 2), and Holmes tremor (n = 2). All patients responded to DBS therapy; motor scores
improved at 6-month and last follow-up. The Vim nucleus was successfully identified,
as the DRT was depicted in all cases. Of ten active DBS contacts in seven leads, four
contacts were located outside of the depicted DRT, and these contacts tended to require
higher stimulation intensity.
Conclusions
The Vim nucleus was successfully identified with FGATIR. Our methods may be useful
to determine optimal DBS trajectory, and potentially improve outcomes.
Keywords
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Article info
Publication history
Published online: January 16, 2019
Accepted:
January 15,
2019
Received in revised form:
December 22,
2018
Received:
August 3,
2018
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
