Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Medical Image Analysis Laboratory (MIAL) and Department of Radiology-Center of Biomedical Imaging (CIBM), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
Medical Image Analysis Laboratory (MIAL) and Department of Radiology-Center of Biomedical Imaging (CIBM), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
World Neurosurg. 2018 May;113:e453-e464. doi: 10.1016/j.wneu.2018.02.055. Epub 2018 Feb 21.
To evaluate functional connectivity (FC) of the ventrolateral thalamus, a common target for drug-resistant essential tremor (ET), resting-state data were analyzed before and 1 year after stereotactic radiosurgical thalamotomy and compared against healthy controls (HCs).
In total, 17 consecutive patients with ET and 10 HCs were enrolled. Tremor network was investigated using the ventrolateral ventral (VLV) thalamic nucleus as the region of interest, extracted with automated segmentation from pretherapeutic diffusion magnetic resonance imaging. Temporal correlations of VLV at whole brain level were evaluated by comparing drug-naïve patients with ET with HCs, and longitudinally, 1 year after stereotactic radiosurgical thalamotomy. 1 year thalamotomy MR signature was always located inside VLV and did not correlate with any of FC measures (P > 0.05). This suggested presence of longitudinal changes in VLV FC independently of the MR signature volume.
Pretherapeutic ET displayed altered VLV FC with left primary sensory-motor cortex, pedunculopontine nucleus, dorsal anterior cingulate, left visual association, and left superior parietal areas. Pretherapeutic negative FC with primary somatosensory cortex and pedunculopontine nucleus correlated with poorer baseline tremor scores (Spearman = 0.04 and 0.01). Longitudinal study displayed changes within right dorsal attention (frontal eye-fields and posterior parietal) and salience (anterior insula) networks, as well as areas involved in hand movement planning or language production.
Our results demonstrated that patients with ET and HCs differ in their left VLV FC to primary somatosensory and supplementary motor, visual association, or brainstem areas (pedunculopontine nucleus). Longitudinal changes display reorganization of dorsal attention and salience networks after thalamotomy. Beside attentional gateway, they are also known for their major role in facilitating a rapid access to the motor system.
评估腹外侧丘脑的功能连接（FC），腹外侧丘脑是药物难治性特发性震颤（ET）的常见靶点，我们对立体定向放射外科丘脑切开术前和术后 1 年的静息态数据进行了分析，并与健康对照（HC）进行了比较。
共纳入 17 例连续 ET 患者和 10 例 HC。使用腹外侧腹（VLV）丘脑核作为感兴趣区，通过术前弥散磁共振成像的自动分割提取震颤网络。通过比较药物-naive ET 患者与 HC，评估 VLV 在全脑水平的时间相关性，并在立体定向放射外科丘脑切开术后 1 年进行纵向比较。1 年丘脑切开术的 MR 特征始终位于 VLV 内，与任何 FC 测量均无相关性（P > 0.05）。这表明 VLV FC 存在纵向变化，与 MR 特征体积无关。
术前 ET 显示 VLV FC 改变，与左侧初级感觉运动皮层、脑桥被盖核、背侧前扣带回、左侧视觉联合区和左侧顶叶上区相关。与初级感觉皮层和脑桥被盖核的术前负 FC 与基线震颤评分较差相关（Spearman = 0.04 和 0.01）。纵向研究显示右侧背侧注意力（额眼区和顶后区）和突显（前岛叶）网络以及参与手部运动规划或语言产生的区域发生变化。
我们的结果表明，ET 患者和 HC 在 VLV 与初级感觉运动、视觉联合或脑干区域（脑桥被盖核）的左侧 FC 存在差异。丘脑切开术后，背侧注意力和突显网络发生纵向变化。除了注意力门户之外，它们还因其在促进快速进入运动系统方面的主要作用而闻名。
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