Tuleasca Constantin, Witjas Tatiana, Van de Ville Dimitri, Najdenovska Elena, Verger Antoine, Girard Nadine, Champoudry Jerome, Thiran Jean-Philippe, Cuadra Meritxell Bach, Levivier Marc, Guedj Eric, Régis Jean
Department of Clinical Neuroscience, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 44-46, BH-08, 1011, Lausanne, Switzerland.
Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
Acta Neurochir (Wien). 2018 Mar;160(3):603-609. doi: 10.1007/s00701-017-3391-x. Epub 2017 Nov 11.
Drug-resistant essential tremor (ET) can benefit from open standard stereotactic procedures, such as deep-brain stimulation or radiofrequency thalamotomy. Non-surgical candidates can be offered either high-focused ultrasound (HIFU) or radiosurgery (RS). All procedures aim to target the same thalamic site, the ventro-intermediate nucleus (e.g., Vim). The mechanisms by which tremor stops after Vim RS or HIFU remain unknown. We used voxel-based morphometry (VBM) on pretherapeutic neuroimaging data and assessed which anatomical site would best correlate with tremor arrest 1 year after Vim RS.
Fifty-two patients (30 male, 22 female; mean age 71.6 years, range 49-82) with right-sided ET benefited from left unilateral Vim RS in Marseille, France. Targeting was performed in a uniform manner, using 130 Gy and a single 4-mm collimator. Neurological (pretherapeutic and 1 year after) and neuroimaging (baseline) assessments were completed. Tremor score on the treated hand (TSTH) at 1 year after Vim RS was included in a statistical parametric mapping analysis of variance (ANOVA) model as a continuous variable with pretherapeutic neuroimaging data. Pretherapeutic gray matter density (GMD) was further correlated with TSTH improvement. No a priori hypothesis was used in the statistical model.
The only statistically significant region was right Brodmann area (BA) 18 (visual association area V2, p = 0.05, cluster size K = 71). Higher baseline GMD correlated with better TSTH improvement at 1 year after Vim RS (Spearman's rank correlation coefficient = 0.002).
Routine baseline structural neuroimaging predicts TSTH improvement 1 year after Vim RS. The relevant anatomical area is the right visual association cortex (BA 18, V2). The question whether visual areas should be included in the targeting remains open.
耐药性特发性震颤（ET）可从开放式标准立体定向手术中获益，如脑深部电刺激或射频丘脑切开术。非手术候选者可选择高聚焦超声（HIFU）或放射外科手术（RS）。所有手术均旨在靶向同一丘脑部位，即腹中间核（如Vim）。Vim放射外科手术或HIFU后震颤停止的机制尚不清楚。我们对治疗前的神经影像数据进行基于体素的形态学测量（VBM），并评估哪个解剖部位与Vim放射外科手术后1年的震颤停止最相关。
52例右侧ET患者（30例男性，22例女性；平均年龄71.6岁，范围49 - 82岁）在法国马赛接受了左侧单侧Vim放射外科手术。使用130 Gy和单个4毫米准直器以统一方式进行靶点定位。完成了神经学（治疗前和治疗后1年）和神经影像（基线）评估。Vim放射外科手术后1年患侧手的震颤评分（TSTH）作为连续变量与治疗前神经影像数据一起纳入统计参数映射方差分析（ANOVA）模型。治疗前灰质密度（GMD）进一步与TSTH改善情况相关。统计模型中未使用先验假设。
唯一具有统计学意义的区域是右侧布罗德曼区（BA）18（视觉联合区V2，p = 0.05，聚类大小K = 71）。较高的基线GMD与Vim放射外科手术后1年更好的TSTH改善相关（斯皮尔曼等级相关系数 = 0.002）。
常规基线结构神经影像可预测Vim放射外科手术后1年的TSTH改善情况。相关解剖区域是右侧视觉联合皮层（BA 18，V2）。视觉区域是否应纳入靶点定位的问题仍未解决。
