Wang Yu-Chi, Grewal Sanjeet S, Middlebrooks Erik H, Worrell Gregory A, Stead Matt, Lundstrom Brian N, Britton Jeffrey W, Wu Min-Hsien, Van Gompel Jamie J
Department of Neurosurgery, Chang Gung Memorial Hospital in Linkou, Chang Gung University, Taiwan; Program of Biomedical Engineering, Graduate Institute of Biomedical Engineering, Chang Gung University, Taiwan.
Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA.
Epilepsy Res. 2019 Jul;153:1-6. doi: 10.1016/j.eplepsyres.2019.03.010. Epub 2019 Mar 19.
Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is a promising treatment for refractory epilepsy; however, it remains challenging to successfully target the ANT. The results of Medtronic Registry for Epilepsy (MORE) supported a frontal transventricular(TV) compared to frontal extraventricular (EV) lead trajectory for ANT DBS may have better coverage of the ANT. Here we report the safety and targeting efficacy of a novel, posterior parietal extraventricular (PEV) approach to the ANT.
We conducted a retrospective analysis of ten patients who underwent bilateral ANT DBS (20 total trajectories) for medically-refractory epilepsy. Similar targeting methodology as the MORE trial was used, and the DBS Intrinsic Template Atlas (DISTAL) was utilized for ANT localization and contact position relative to ANT. Clinical data were assessed for DBS targeting efficacy and surgical complications.
The demonstrated PEV trajectory showed a successful ANT targeting rate of 90% bilaterally. Two or more contacts within ANT were presented in 75% of all leads. Mean contact number in ANT was 2.2+ 1.2. There were no intracranial hemorrhages, cerebrospinal fluid leakage, or permanent neurologic deficits.
In this small series, the novel PEV for ANT DBS is feasible with good targeting accuracy and potential safety advantages. The high accuracy of the PEV trajectory suggests that it is a reasonable alternative trajectory for ANT DBS. Larger studies will be needed to assess this trajectory on clinical outcome of DBS treatment to epilepsy.
丘脑前核（ANT）的深部脑刺激（DBS）是治疗难治性癫痫的一种有前景的方法；然而，成功靶向ANT仍然具有挑战性。美敦力癫痫注册研究（MORE）的结果支持，与额部脑室外（EV）导联轨迹相比，额部经脑室（TV）导联轨迹用于ANT DBS可能对ANT有更好的覆盖。在此，我们报告一种新的、顶叶后外侧脑室外（PEV）入路至ANT的安全性和靶向有效性。
我们对10例因药物难治性癫痫接受双侧ANT DBS（共20条轨迹）的患者进行了回顾性分析。采用了与MORE试验相似的靶向方法，并使用DBS固有模板图谱（DISTAL）进行ANT定位以及相对于ANT的触点位置确定。评估临床数据以了解DBS靶向有效性和手术并发症。
所展示的PEV轨迹显示双侧ANT成功靶向率为90%。所有导联中有75%在ANT内有两个或更多触点。ANT内的平均触点数为2.2±1.2。未发生颅内出血、脑脊液漏或永久性神经功能缺损。
在这个小样本系列中，用于ANT DBS的新型PEV是可行的，具有良好的靶向准确性和潜在的安全优势。PEV轨迹的高准确性表明它是ANT DBS的一种合理替代轨迹。需要更大规模的研究来评估该轨迹对DBS治疗癫痫临床结局的影响。
