Department of Neurosurgery, Academic Medical Center, Amsterdam, The Nether-lands.
Department of Neurology and Clinical Neurophysiology, Academic Med-ical Center, Amsterdam, The Netherlands.
Oper Neurosurg (Hagerstown). 2018 Aug 1;15(2):144-152. doi: 10.1093/ons/opx232.
Ventral intermediate nucleus (VIM) deep brain stimulation (DBS) and posterior subthalamic area (PSA) DBS suppress tremor in essential tremor (ET) patients, but it is not clear which target is optimal. Aligning both targets in 1 surgical trajectory would facilitate exploring stimulation of either target in a single patient.
To evaluate aligning VIM and PSA in 1 surgical trajectory for DBS in ET.
Technical aspects of trajectories, intraoperative stimulation findings, final electrode placement, target used for chronic stimulation, and adverse and beneficial effects were evaluated.
In 17 patients representing 33 trajectories, we successfully aligned VIM and PSA targets in 26 trajectories. Trajectory distance between targets averaged 7.2 (range 6-10) mm. In all but 4 aligned trajectories, optimal intraoperative tremor suppression was obtained in the PSA. During follow-up, active electrode contacts were located in PSA in the majority of cases. Overall, successful tremor control was achieved in 69% of patients. Stimulation-induced dysarthria or gait ataxia occurred in, respectively, 56% and 44% of patients. Neither difference in tremor suppression or side effects was noted between aligned and nonaligned leads nor between the different locations of chronic stimulation.
Alignment of VIM and PSA for DBS in ET is feasible and enables intraoperative exploration of both targets in 1 trajectory. This facilitates positioning of electrode contacts in both areas, where multiple effective points of stimulation can be found. In the majority of aligned leads, optimal intraoperative and chronic stimulation were located in the PSA.
腹侧中间核（VIM）深部脑刺激（DBS）和后丘脑底核（PSA）DBS 可抑制原发性震颤（ET）患者的震颤，但尚不清楚哪种靶标最佳。在 1 个手术轨迹中对准这两个靶点将有助于在单个患者中探索对任一靶点的刺激。
评估在 ET 的 DBS 中，在 1 个手术轨迹中对准 VIM 和 PSA。
评估轨迹的技术方面、术中刺激发现、最终电极放置、用于慢性刺激的目标以及不良反应和有益效果。
在代表 33 条轨迹的 17 名患者中，我们成功地在 26 条轨迹中对准了 VIM 和 PSA 目标。目标之间的轨迹距离平均为 7.2（6-10）mm。在所有除 4 条对准的轨迹之外，在 PSA 中均获得了最佳的术中震颤抑制效果。在随访期间，主动电极接触点位于 PSA 的大多数情况下。总体而言，69%的患者获得了成功的震颤控制。分别有 56%和 44%的患者出现了因刺激引起的构音障碍或步态共济失调。在震颤抑制或副作用方面，对准和未对准的导联之间以及慢性刺激的不同部位之间均未发现差异。
在 ET 的 DBS 中对准 VIM 和 PSA 是可行的，可在 1 个轨迹中探索两个目标。这便于在两个区域中定位电极接触点，在这两个区域中可以找到多个有效的刺激点。在大多数对准的导联中，最佳的术中及慢性刺激位于 PSA。
