Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan.
Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan.
World Neurosurg. 2022 Aug;164:e1103-e1110. doi: 10.1016/j.wneu.2022.05.113. Epub 2022 May 31.
Although stereotactic ablation surgery is known to ameliorate involuntary movement dramatically, little is known regarding alterations in whole-brain networks due to disruption of the deep brain nucleus. To explore changes in the whole-brain network after thalamotomy, we analyzed structural and functional connectivity alterations using resting-state functional magnetic resonance imaging and diffusion tensor imaging in patients with essential tremor who had undergone focused ultrasound (FUS) thalamotomy.
Seven patients with intractable essential tremors and 7 age-matched healthy controls were enrolled in the study. The tremor score in essential tremor patients was assessed, and resting-state functional magnetic resonance imaging and diffusion tensor imaging were performed before and 3 months after left ventral intermediate nucleus thalamotomy using FUS.
There was a significant improvement in the tremor of the right hand after FUS thalamotomy. Seed-based functional connectivity analysis revealed a significant increase in functional connectivity between the left thalamus and the caudal part of the dorsal premotor cortex after FUS thalamotomy. Structural connectivity analysis did not detect statistically significant changes between before and after FUS. There was no correlation between the changes in functional connectivity and tremor score.
Although the number of cases is small, our results show that functional connectivity between the thalamus and the premotor cortex increases after the amelioration of tremors by FUS thalamotomy. The lack of correlation between increased functional connectivity and clinical tremor scores suggests that the observed increase in functional connectivity may be a compensatory change in the secondary sensorimotor changes that occur after thalamotomy.
立体定向消融术可显著改善不自主运动，但对于因深部脑核破坏而导致的全脑网络改变知之甚少。为了探讨丘脑切开术后全脑网络的变化，我们对接受聚焦超声（FUS）丘脑切开术的特发性震颤患者使用静息态功能磁共振成像和弥散张量成像分析结构和功能连接的改变。
本研究纳入了 7 例难治性特发性震颤患者和 7 名年龄匹配的健康对照者。在使用 FUS 进行左侧腹侧中间核丘脑切开术前和术后 3 个月评估特发性震颤患者的震颤评分，并进行静息态功能磁共振成像和弥散张量成像。
FUS 丘脑切开术后右手震颤明显改善。基于种子的功能连接分析显示，FUS 丘脑切开术后，左侧丘脑与背侧运动前皮质的尾部之间的功能连接显著增加。结构连接分析未发现 FUS 前后有统计学意义的变化。功能连接的变化与震颤评分之间无相关性。
尽管病例数较少，但我们的结果表明，FUS 丘脑切开术后震颤改善后，丘脑与运动前皮质之间的功能连接增加。功能连接的增加与临床震颤评分之间缺乏相关性表明，观察到的功能连接增加可能是丘脑切开术后发生的次级感觉运动变化的代偿性改变。
