Fenoy Albert J, Schiess Mya C
Department of Neurosurgery, Mischer Neuroscience Institute, McGovern Medical School, University of Texas - Houston Health Science Center, Houston, TX, USA.
Department of Neurology, Movement Disorders and Neurodegenerative Disease Program, McGovern Medical School, University of Texas - Houston Health Science Center, Houston, TX, USA.
Neuromodulation. 2017 Jul;20(5):429-436. doi: 10.1111/ner.12585. Epub 2017 Mar 3.
Targeting the dentato-rubro-thalamic tract (DRTt) has been suggested to be efficacious in deep brain stimulation (DBS) for tremor suppression, both in case reports and post-hoc analyses. This prospective observational study sought to analyze outcomes after directly targeting the DRTt in tremor patients.
20 consecutively enrolled intention tremor patients obtained pre-operative MRI with diffusion tensor (dTi) sequences. Mean baseline tremor amplitude based on The Essential Tremor Rating Assessment Scale was recorded. The DRTt was drawn for each individual on StealthViz software (Medtronic) using the dentate nucleus as the seed region and the ipsilateral pre-central gyrus as the end region and then directly targeted during surgery. Intraoperative testing confirmed successful tremor control. Post-operative analysis of electrode position relative to the DRTt was performed, as was post-operative assessment of tremor improvement.
The mean age of patients was 66.8 years; mean duration of tremor was 16 years. Mean voltage for the L electrode = 3.4 V; R = 2.6 V. Mean distance from the center of the active electrode contact to the DRTt was 0.9 mm on the L, and 0.8 mm on the R. Improvement in arm tremor amplitude from baseline after DBS was significant (P < 0.001).
Direct targeting of the DRTt in DBS is an effective strategy for tremor suppression. Accounting for hardware, software, and model limitations, depiction of the DRTt allows for placement of electrode contacts directly within the fiber tract for modulation despite any anatomical variation, which reproducibly resulted in good tremor control.
在病例报告和事后分析中均表明，靶向齿状核-红核-丘脑束（DRTt）在深部脑刺激（DBS）抑制震颤方面具有疗效。这项前瞻性观察性研究旨在分析震颤患者直接靶向DRTt后的结果。
20例连续入组的意向性震颤患者术前行带有扩散张量（dTi）序列的MRI检查。记录基于原发性震颤评定量表的平均基线震颤幅度。在StealthViz软件（美敦力公司）上以齿状核为种子区域、同侧中央前回为终点区域，为每个个体绘制DRTt，然后在手术中直接靶向该区域。术中测试证实震颤得到成功控制。对电极相对于DRTt的位置进行术后分析，并对震颤改善情况进行术后评估。
患者的平均年龄为66.8岁；平均震颤持续时间为16年。左电极的平均电压 = 3.4V；右电极 = 2.6V。有源电极触点中心到DRTt的平均距离，左侧为0.9mm，右侧为0.8mm。DBS术后手臂震颤幅度较基线有显著改善（P < 0.001）。
DBS中直接靶向DRTt是抑制震颤的有效策略。考虑到硬件、软件和模型的局限性，DRTt的描绘使得电极触点能够直接放置在纤维束内进行调节，尽管存在任何解剖变异，这都能可靠地实现良好的震颤控制。
