Anthofer Judith Maria, Steib Kathrin, Lange Max, Rothenfusser Eva, Fellner Claudia, Brawanski Alexander, Schlaier Juergen
Department of Neurosurgery, Universitatsklinikum Regensburg Klinik und Poliklinik fur Neurochirurgie Ringgold Standard Institution, Regensburg, Germany.
Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany.
J Neurol Surg A Cent Eur Neurosurg. 2017 Jul;78(4):350-357. doi: 10.1055/s-0036-1597894. Epub 2017 Mar 20.
Some patients under thalamic deep brain stimulation (DBS) for essential tremor (ET) experience habituation of tremor reduction. The nucleus ventralis intermedius (Vim) is the current main target side for ET in DBS. However, the dentatorubrothalamic tract (DRTT) is considered the relevant structure to stimulate. We investigated the distance between the active contact of the DBS electrode and the DRTT and compared this distance in patients with habituation of tremor reduction and good responders. In this retrospective study, we performed deterministic fiber tracking of the DRTT in 6 patients (12 hemispheres) with ET who underwent DBS in the Vim. We subsequently measured the distance between the active contact of the electrode and the ipsilateral DRTT in both hemispheres. The clinical tremor response of those 6 patients was analyzed accordingly. The distance between the active contact and the DRTT in patients with better and constant clinical tremor reduction was shorter (mean distance: 2.9 ± 2.2 mm standard deviation [SD]) than in patients who showed habituation of their response (mean distance: 6.1 ± 3.9 mm SD). After re-placement of a thalamic electrode inside the DRTT in one patient who experienced unsatisfying tremor reduction due to habituation of stimulation, the tremor alleviation was significant and persistent at a 13-month follow-up. This retrospective analysis suggests that recurrence of ET tremor under chronic DBS might be associated with a larger distance between the DRTT and the active lead contact, in comparison with the smaller distances in patients with persistently good tremor control.
一些接受丘脑深部脑刺激（DBS）治疗特发性震颤（ET）的患者会出现震颤减轻效果的适应性变化。腹中间核（Vim）是目前DBS治疗ET的主要靶点。然而，齿状红核丘脑束（DRTT）被认为是相关的刺激结构。我们研究了DBS电极的有效触点与DRTT之间的距离，并比较了震颤减轻效果出现适应性变化的患者和反应良好患者的这一距离。在这项回顾性研究中，我们对6例接受Vim区DBS治疗的ET患者（12个半球）进行了DRTT的确定性纤维束追踪。随后，我们测量了两个半球中电极有效触点与同侧DRTT之间的距离。并据此分析了这6例患者的临床震颤反应。临床震颤减轻效果较好且持续稳定的患者，其有效触点与DRTT之间的距离较短（平均距离：2.9±2.2毫米标准差[SD]），而反应出现适应性变化的患者该距离较长（平均距离：6.1±3.9毫米SD）。在1例因刺激适应性变化导致震颤减轻效果不佳的患者中，将丘脑电极重新放置在DRTT内后，震颤缓解效果显著且在13个月的随访中持续存在。这项回顾性分析表明，与震颤控制持续良好的患者相比，慢性DBS治疗下ET震颤复发可能与DRTT和有效导联触点之间的距离较大有关。
