Pae Chongwon, Kim Myung Ji, Chang Won Seok, Jung Hyun Ho, Chang Kyung Won, Eo Jinseok, Park Hae-Jeong, Chang Jin Woo
1Center for Systems and Translational Brain Sciences, Institute of Human Complexity and Systems Science, Yonsei University, Seoul.
2Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul.
J Neurosurg. 2022 Jul 22;138(2):318-328. doi: 10.3171/2022.5.JNS22324. Print 2023 Feb 1.
Thalamotomy at the nucleus ventralis intermedius using MR-guided focused ultrasound has been an effective treatment method for essential tremor (ET). However, this is not true for all cases, even for successful ablation. How the brain differs in patients with ET between those with long-term good and poor outcomes is not clear. To analyze the functional connectivity difference between patients in whom thalamotomy was effective and those in whom thalamotomy was ineffective and its prognostic role in ET treatment, the authors evaluated preoperative resting-state functional MRI in thalamotomy-treated patients.
Preoperative resting-state functional MRI data in 85 patients with ET, who were experiencing tremor relief at the time of treatment and were followed up for a minimum of 6 months after the procedure, were collected for the study. The authors conducted a graph independent component analysis of the functional connectivity matrices of tremor-related networks. The patients were divided into thalamotomy-effective and thalamotomy-ineffective groups (thalamotomy-effective group, ≥ 50% motor symptom reduction; thalamotomy-ineffective group, < 50% motor symptom reduction at 6 months after treatment) and the authors compared network components between groups.
Seventy-two (84.7%) of the 85 patients showed ≥ 50% tremor reduction from baseline at 6 months after thalamotomy. The network analysis shows significant suppression of functional network components with connections between the areas of the cerebellum and the basal ganglia and thalamus, but enhancement of those between the premotor cortex and supplementary motor area in the noneffective group compared to the effective group.
The present study demonstrates that patients in the noneffective group have suppressed functional subnetworks in the cerebellum and subcortex regions and have enhanced functional subnetworks among motor-sensory cortical networks compared to the thalamotomy-effective group. Therefore, the authors suggest that the functional connectivity pattern might be a possible predictive factor for outcomes of MR-guided focused ultrasound thalamotomy.
使用磁共振引导聚焦超声在腹中间核进行丘脑切开术一直是治疗特发性震颤（ET）的有效方法。然而，并非所有病例都是如此，即使是成功的消融也是如此。ET患者中远期疗效良好和不佳者的大脑差异尚不清楚。为了分析丘脑切开术有效和无效患者之间的功能连接差异及其在ET治疗中的预后作用，作者评估了接受丘脑切开术治疗患者的术前静息态功能磁共振成像。
收集85例ET患者的术前静息态功能磁共振成像数据，这些患者在治疗时震颤得到缓解，术后至少随访6个月。作者对震颤相关网络的功能连接矩阵进行了图形独立成分分析。将患者分为丘脑切开术有效组和无效组（丘脑切开术有效组，运动症状减轻≥50%；丘脑切开术无效组，治疗后6个月运动症状减轻<50%），并比较两组之间的网络成分。
85例患者中有72例（84.7%）在丘脑切开术后6个月时震颤较基线减轻≥50%。网络分析显示，与有效组相比，无效组中连接小脑、基底神经节和丘脑区域的功能网络成分受到显著抑制，但运动前皮质和辅助运动区之间的成分增强。
本研究表明，与丘脑切开术有效组相比，无效组患者小脑和皮质下区域的功能子网受到抑制，而运动感觉皮质网络之间的功能子网增强。因此，作者认为功能连接模式可能是磁共振引导聚焦超声丘脑切开术疗效的一个可能预测因素。
