Paff Michelle, Boutet Alexandre, Germann Jürgen, Elias Gavin J B, Chow Clement T, Loh Aaron, Kucharczyk Walter, Fasano Alfonso, Schwartz Michael L, Lozano Andres M
University Health Network (MP, AB, JG, GJBE, CTC, AL, WK, AML), Toronto; Joint Department of Medical Imaging (AB, WK), University of Toronto; Edmond J. Safra Program in Parkinson's Disease (AF), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, and Division of Neurology (AF), University of Toronto; Krembil Brain Institute (AF); Division of Neurosurgery (MLS), Sunnybrook Health Sciences Center, University of Toronto; and Division of Neurosurgery (AML), Department of Surgery, Toronto Western Hospital and University of Toronto, Ontario, Canada.
Neurol Clin Pract. 2021 Aug;11(4):e497-e503. doi: 10.1212/CPJ.0000000000001013.
Focused ultrasound thalamotomy is an effective treatment for tremor; however, side effects may occur. The purpose of the present study was to investigate the spatial relationship between thalamotomies and specific sensory side effects and their functional connectivity with somatosensory cortex and relationship to the medial lemniscus (ML).
Sensory adverse effects were categorized into 4 groups based on the location of the disturbance: face/mouth/tongue numbness/paresthesia, hand-only paresthesia, hemibody/limb paresthesia, and dysgeusia. Then, areas of significant risk (ASRs) for each category were defined using voxel-wise mass univariate analysis and overlaid on corresponding odds ratio maps. The ASR associated with the maximum risk was used as a region of interest in a normative functional connectome to determine side effect-specific functional connectivity. Finally, each ASR was overlaid on the ML derived from normative template.
Of 103 patients, 17 developed sensory side effects after thalamotomy persisting 3 months after the procedures. Lesions producing sensory side effects extended posteriorly into the principle sensory nucleus of the thalamus or below the thalamus in the ML. The topography of sensory adverse effects followed the known somatotopy of the ML and the sensory nucleus. Functional connectivity patterns between each sensory-specific thalamic seed and the primary somatosensory areas supported the role of the middle insula in processing of gustatory information and in multisensory integration.
Distinct regions in the sensory thalamus and its afferent connections rise to specific sensory disturbances. These findings demonstrate the relationship between the sensory thalamus, ML, and bilateral sensory cortical areas.
聚焦超声丘脑切开术是治疗震颤的有效方法；然而，可能会出现副作用。本研究的目的是调查丘脑切开术与特定感觉副作用之间的空间关系，以及它们与躯体感觉皮层的功能连接和与内侧丘系（ML）的关系。
根据干扰部位将感觉不良反应分为4组：面部/口腔/舌部麻木/感觉异常、仅手部感觉异常、半身/肢体感觉异常和味觉障碍。然后，使用体素-wise质量单变量分析定义每个类别的显著风险区域（ASR），并将其叠加在相应的优势比图上。将与最大风险相关的ASR用作标准功能连接组中的感兴趣区域，以确定副作用特异性功能连接。最后，将每个ASR叠加在从标准模板导出的ML上。
103例患者中，17例在丘脑切开术后出现感觉副作用，术后3个月仍持续存在。产生感觉副作用的病变向后延伸至丘脑的主要感觉核或ML中丘脑下方。感觉不良反应的地形遵循ML和感觉核已知的躯体定位。每个感觉特异性丘脑种子与初级躯体感觉区域之间的功能连接模式支持了岛叶中部在味觉信息处理和多感觉整合中的作用。
感觉丘脑中的不同区域及其传入连接会引发特定的感觉障碍。这些发现证明了感觉丘脑、ML和双侧感觉皮层区域之间的关系。
