Prospective Tractography-Based Targeting for Improved Safety of Focused Ultrasound Thalamotomy.
Neurosurgery
; 84(1): 160-168, 2019 01 01.
Article
em En
| MEDLINE
| ID: mdl-29579287
ABSTRACT
BACKGROUND:
Focused ultrasound thalamotomy (FUS-T) was recently approved for the treatment of refractory essential tremor (ET). Despite its noninvasive approach, FUS-T reinitiated concerns about the adverse effects and long-term efficacy after lesioning.OBJECTIVE:
To prospectively assess the outcomes of FUS-T in 10 ET patients using tractography-based targeting of the ventral intermediate nucleus (VIM).METHODS:
VIM was identified at the intercommissural plane based on its neighboring tracts the pyramidal tract and medial lemniscus. FUS-T was performed at the center of tractography-defined VIM. Tremor outcomes, at baseline and 3 mo, were assessed independently by the Tremor Research Group. We analyzed targeting coordinates, clinical outcomes, and adverse events. The FUS-T lesion location was analyzed in relation to unbiased thalamic parcellation using probabilisitic tractography. Quantitative diffusion-weighted imaging changes were also studied in fiber tracts of interest.RESULTS:
The tractography coordinates were more anterior than the standard. Intraoperatively, therapeutic sonications at the tractography target improved tremor (>50% improvement) without motor or sensory side effects. Sustained improvement in tremor was observed at 3 mo (tremor score 18.3 ± 6.9 vs 8.1 ± 4.4, P = .001). No motor weakness and sensory deficits after FUS-T were observed during 6-mo follow-up. Ataxia was observed in 3 patients. FUS-T lesions overlapped with the VIM parcellated with probablisitic tractography. Significant microstructural changes were observed in the white matter connecting VIM with cerebellum and motor cortex.CONCLUSION:
This is the first report of prospective VIM targeting with tractography for FUS-T. These results suggest that tractography-guided targeting is safe and has satisfactory short-term clinical outcomes.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Tálamo
/
Terapia por Ultrassom
/
Tremor Essencial
/
Imagem de Tensor de Difusão
Tipo de estudo:
Observational_studies
/
Prognostic_studies
Idioma:
En
Revista:
Neurosurgery
Ano de publicação:
2019
Tipo de documento:
Article