TY - JOUR
T1 - Deep brain stimulation for essential tremor: Aligning thalamic and posterior subthalamic targets in 1 surgical trajectory
AU - Bot, Maarten
AU - van Rootselaar, Fleur
AU - Contarino, Maria Fiorella
AU - Odekerken, Vincent
AU - Dijk, Joke
AU - de Bie, Rob
AU - Schuurman, Richard
AU - van den Munckhof, Pepijn
PY - 2018
Y1 - 2018
N2 - BACKGROUND: Ventral intermediate nucleus (VIM) deep brain stimulation (DBS) and posterior subthalamic area (PSA) DBS suppress tremor in essential tremor (ET) patients, but it is not clear which target is optimal. Aligning both targets in 1 surgical trajectory would facilitate exploring stimulation of either target in a single patient. OBJECTIVE: To evaluate aligning VIM and PSA in 1 surgical trajectory for DBS in ET. METHODS: Technical aspects of trajectories, intraoperative stimulation findings, final electrode placement, target used for chronic stimulation, and adverse and beneficial effects were evaluated. RESULTS: In 17 patients representing 33 trajectories, we successfully aligned VIM and PSA targets in 26 trajectories. Trajectory distance between targets averaged 7.2 (range 6-10) mm. In all but 4 aligned trajectories, optimal intraoperative tremor suppression was obtained in the PSA. During follow-up, active electrode contacts were located in PSA in the majority of cases. Overall, successful tremor control was achieved in 69% of patients. Stimulation-induced dysarthria or gait ataxia occurred in, respectively, 56% and 44% of patients. Neither difference in tremor suppression or side effects was noted between aligned and nonaligned leads nor between the different locations of chronic stimulation. CONCLUSION: Alignment of VIM and PSA for DBS in ET is feasible and enables intraoperative exploration of both targets in 1 trajectory. This facilitates positioning of electrode contacts in both areas, where multiple effective points of stimulation can be found. In the majority of aligned leads, optimal intraoperative and chronic stimulation were located in the PSA.
AB - BACKGROUND: Ventral intermediate nucleus (VIM) deep brain stimulation (DBS) and posterior subthalamic area (PSA) DBS suppress tremor in essential tremor (ET) patients, but it is not clear which target is optimal. Aligning both targets in 1 surgical trajectory would facilitate exploring stimulation of either target in a single patient. OBJECTIVE: To evaluate aligning VIM and PSA in 1 surgical trajectory for DBS in ET. METHODS: Technical aspects of trajectories, intraoperative stimulation findings, final electrode placement, target used for chronic stimulation, and adverse and beneficial effects were evaluated. RESULTS: In 17 patients representing 33 trajectories, we successfully aligned VIM and PSA targets in 26 trajectories. Trajectory distance between targets averaged 7.2 (range 6-10) mm. In all but 4 aligned trajectories, optimal intraoperative tremor suppression was obtained in the PSA. During follow-up, active electrode contacts were located in PSA in the majority of cases. Overall, successful tremor control was achieved in 69% of patients. Stimulation-induced dysarthria or gait ataxia occurred in, respectively, 56% and 44% of patients. Neither difference in tremor suppression or side effects was noted between aligned and nonaligned leads nor between the different locations of chronic stimulation. CONCLUSION: Alignment of VIM and PSA for DBS in ET is feasible and enables intraoperative exploration of both targets in 1 trajectory. This facilitates positioning of electrode contacts in both areas, where multiple effective points of stimulation can be found. In the majority of aligned leads, optimal intraoperative and chronic stimulation were located in the PSA.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85055500487&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29281074
U2 - https://doi.org/10.1093/ons/opx232
DO - https://doi.org/10.1093/ons/opx232
M3 - Article
C2 - 29281074
SN - 2332-4252
VL - 15
SP - 144
EP - 152
JO - Operative neurosurgery
JF - Operative neurosurgery
IS - 2
ER -