Division of Stereotaxy and MR-Based Operative Techniques/Department of Neurosurgery, Bonn University, Bonn, Germany.
Neurosurgery. 2011 Apr;68(4):1069-75; discussion 1075-6. doi: 10.1227/NEU.0b013e31820a1a20.
Deep brain stimulation (DBS) has been proven to alleviate tremor of various origins. Distinct regions have been targeted. One explanation for good clinical tremor control might be the involvement of the dentatorubrothalamic tract (DRT) as has been suggested in superficial (thalamic) and inferior (posterior subthalamic) target regions. Beyond a correlation with atlas data and the postmortem evaluation of patients treated with lesion surgery, proof for the involvement of DRT in tremor reduction in the living, the scope of this work, is elusive.
To report a case of unilateral refractory tremor in tremor-dominant Parkinson disease treated with thalamic DBS.
Preoperative diffusion tensor imaging (DTI) was performed. Correlation with individual DBS electrode contact locations was obtained through postoperative fusion of helical computed tomography (CT) data with DTI fiber tracking.
Tremor was alleviated effectively. An evaluation of the active electrode contact position revealed clear involvement of the DRT in tremor control. A closer evaluation of clinical effects and side effects revealed a highly detailed individual fiber map of the subthalamic region with DTI fiber tracking.
This is the first time the involvement of the DRT in tremor reduction through DBS has been shown in the living. The combination of DTI with postoperative CT and the evaluation of the electrophysiological environment of distinct electrode contacts led to an individual detailed fiber map and might be extrapolated to refined DTI-based targeting strategies in the future. Data acquisition for a larger study group is the topic of our ongoing research.
深部脑刺激（DBS）已被证明可缓解各种来源的震颤。已经针对不同的区域进行了靶向治疗。震颤控制良好的一种解释可能是齿状核红核束（DRT）的参与，正如在浅表（丘脑）和下（后丘脑下）目标区域所建议的那样。除了与图谱数据的相关性以及对接受病变手术治疗的患者的死后评估之外，DRT 在活体中减轻震颤的作用的证据，即本工作的范围，仍然难以捉摸。
报告一例震颤为主型帕金森病患者接受丘脑 DBS 单侧难治性震颤的病例。
进行术前弥散张量成像（DTI）。通过将螺旋 CT（CT）数据与 DTI 纤维追踪术后融合，获得与个体 DBS 电极接触位置的相关性。
震颤得到有效缓解。对活动电极接触位置的评估显示 DRT 明显参与了震颤控制。对临床效果和副作用的更详细评估显示，通过 DTI 纤维追踪获得了亚丘脑区域的高度详细的个体纤维图。
这是首次在活体中通过 DBS 显示 DRT 在震颤缓解中的参与。将 DTI 与术后 CT 相结合，并评估不同电极接触的电生理环境，可得出个体详细的纤维图，并可能在未来推广到基于 DTI 的更精细的靶向策略。我们正在进行的研究的主题是为更大的研究组采集数据。
