Grewal Sanjeet S, Middlebrooks Erik H, Okromelidze Lela, Gosden Grant P, Tatum William O, Lundstrom Brian N, Worrell Gregory A, Wharen Robert E, Van Gompel Jamie J
Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA.
Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA.
World Neurosurg. 2020 Jul;139:e70-e77. doi: 10.1016/j.wneu.2020.03.107. Epub 2020 Apr 14.
Preoperative thalamic targeting methods have historically relied on indirect targeting techniques that do not fully account for variances in anatomy or for thalamic atrophy in epilepsy. We aimed to address variability noted between traditional indirect targeting and direct targeting methods for the anterior nucleus of the thalamus (ANT).
Fifteen consecutive patients undergoing ANT deep brain stimulator placement were evaluated (30 thalamic nuclei). Direct ANT targeting was performed using a fast gray matter acquisition T1 inversion recovery sequence and compared with standard stereotactic coordinates. Thalamic volumes were calculated for each patient, and degree of thalamic volume loss was assessed compared with matched control subjects. Vertex analysis was performed to assess shape changes in the thalamus compared with age- and sex-matched subjects.
There was significant variation between direct and indirect targets in the y-axis and z-axis on both sides. On the left, the direct target was located at y = 2 ± 1.3 mm and z = 9.3 ± 1.8 mm (both P = 0.02). On the right, the direct target was located at y = 2.9 ± 1.8 mm and z = 9.2 ± 2 mm (both P ≤ 0.0003). There was no significant difference in the x-coordinate on either side (P > 0.5). Additionally, there was a correlation between thalamic volume and difference between direct and indirect targets in the y-axis and the z-axis.
We showed a significant difference in direct and indirect targeting in the y-axis and z-axis when targeting the ANT for deep brain stimulation for epilepsy. This difference is correlated to thalamic volume, with a larger difference noted in patients with thalamic atrophy.
历史上，术前丘脑靶向方法一直依赖于间接靶向技术，这些技术并未充分考虑解剖结构的差异或癫痫患者的丘脑萎缩情况。我们旨在解决传统间接靶向与丘脑前核（ANT）直接靶向方法之间存在的变异性问题。
对连续15例接受ANT深部脑刺激器植入的患者进行评估（共30个丘脑核团）。使用快速灰质采集T1反转恢复序列进行ANT直接靶向，并与标准立体定向坐标进行比较。计算每位患者的丘脑体积，并与匹配的对照受试者相比评估丘脑体积损失程度。进行顶点分析以评估与年龄和性别匹配的受试者相比丘脑的形状变化。
两侧y轴和z轴上直接靶点与间接靶点之间存在显著差异。在左侧，直接靶点位于y = 2±1.3 mm和z = 9.3±1.8 mm处（P均= 0.02）。在右侧，直接靶点位于y = 2.9±1.8 mm和z = 9.2±2 mm处（P均≤0.0003）。两侧x坐标无显著差异（P>0.5）。此外，丘脑体积与y轴和z轴上直接靶点与间接靶点之间的差异存在相关性。
我们发现，在为癫痫患者进行深部脑刺激而靶向ANT时，y轴和z轴上的直接靶向与间接靶向存在显著差异。这种差异与丘脑体积相关，在丘脑萎缩患者中差异更大。
