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Efficacy of Fiber Tractography in the Stereotactic Surgery of the Thalamus for Patients with Essential Tremor.

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  • Additional Information
    • Source:
      Publisher: Japan Neurosurgical Society Country of Publication: Japan NLM ID: 0400775 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1349-8029 (Electronic) Linking ISSN: 04708105 NLM ISO Abbreviation: Neurol Med Chir (Tokyo) Subsets: MEDLINE
    • Publication Information:
      Original Publication: Tokyo : Japan Neurosurgical Society.
    • Subject Terms:
      Diffusion Tensor Imaging* ; Stereotaxic Techniques*; Essential Tremor/*surgery ; Thalamus/*surgery; Aged ; Cerebellum/physiopathology ; Deep Brain Stimulation/instrumentation ; Electrodes, Implanted ; Essential Tremor/physiopathology ; Essential Tremor/therapy ; Female ; Humans ; Intraoperative Complications/prevention & control ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Motor Cortex/physiopathology ; Nerve Fibers/pathology ; Neural Pathways/physiopathology ; Neural Pathways/surgery ; Neuroimaging ; Retrospective Studies ; Thalamus/diagnostic imaging ; Thalamus/physiopathology ; Tomography, X-Ray Computed ; Treatment Outcome
    • Abstract:
      Several targets and targeting methods are utilized in stereotactic surgery to achieve tremor suppression for patients with intractable tremor. Recent developments in magnetic resonance imaging, including diffusion tensor imaging, have enabled the setting of appropriate targets in stereotactic surgery. In this retrospective study, the optimal target to suppress tremors in stereotactic surgery was explored using diffusion tensor image-based fiber tractography. Four tracts were focused on in this study, namely: the cerebello-thalamo-premotor cortical fiber tract, cerebello-thalamo-primary motor cortical fiber tract, spino-thalamo-somatosensory cortical fiber tract, and pyramidal tract. In 10 patients with essential tremor, we evaluated the thalamotomy lesions and active contacts of the lead in thalamic stimulation by diffusion tensor image-based fiber tractography to reveal which part of the cerebral cortex is most affected by stereotactic surgery. Tremor suppression and adverse events were also evaluated in the patients involved in this study. Consequently, the good tremor suppression was achieved in all patients. There had been no permanent adverse events 3 months after surgery. Twelve lesions in thalamotomy patients or active contacts of the lead in thalamic stimulation patients were on the cerebello-thalamo-premotor cortical fiber tract (12/14 lesions or active contacts: 86%). In conclusion, the cerebello-thalamo-premotor cortical fiber tract may be an optimal target for tremor suppression. Diffusion tensor image-based fiber tractography may enable us to both determine the optimal target to achieve strong tremor suppression and to reduce the number of adverse events by keeping lesions or electrodes away from important fiber tracts, such as the pyramidal tract and spinothalamic fibers.
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    • Contributed Indexing:
      Keywords: diffusion tensor image; essential tremor; fiber tractography; premotor cortex; thalamus
    • Publication Date:
      Date Created: 20170502 Date Completed: 20180608 Latest Revision: 20181113
    • Publication Date:
      20250114
    • Accession Number:
      PMC5566698
    • Accession Number:
      10.2176/nmc.oa.2016-0277
    • Accession Number:
      28458383