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Multi-institutional evaluation of deep brain stimulation targeting using probabilistic connectivity-based thalamic

Nader Pouratian1, Zhong Zheng, Ausaf A Bari

  • 1Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. npouratian@mednet.ucla.edu

Journal of Neurosurgery
|August 23, 2011
PubMed
Summary

This study introduces a new method for deep brain stimulation (DBS) targeting in tremor treatment, using brain connectivity to pinpoint the best thalamic location. This patient-specific approach may improve DBS surgery precision and effectiveness.

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Area of Science:

  • Neurosurgery
  • Neurology
  • Medical Imaging

Background:

  • Traditional MR imaging lacks internal anatomical detail for precise preoperative stereotactic planning in tremor treatment.
  • Current methods often rely on indirect targeting using atlas-derived coordinates.

Purpose of the Study:

  • To investigate the role of probabilistic tractography-based thalamic segmentation for deep brain stimulation (DBS) targeting in tremor treatment.
  • To preliminarily assess a novel, patient-specific targeting approach for DBS.

Main Methods:

  • Studied six patients undergoing bilateral DBS for upper-extremity tremor.
  • Derived connectivity-based thalamic segmentations by identifying thalamic voxel connectivity with 7 cortical regions.
  • Retrospectively analyzed optimal DBS contact locations against these segmentations.
  • Validated findings across two institutions.

Main Results:

  • Connectivity-based segmentation identified distinct thalamic regions with unique cortical connectivity patterns.
  • The most efficacious DBS contact for tremor control colocalized with thalamic voxels highly connected to the premotor cortex, not the primary motor cortex.
  • Localization of the premotor cortex-defined thalamic region was variable relative to anatomical landmarks.

Conclusions:

  • A novel method for targeting thalamic DBS in tremor patients based on individualized connectivity patterns was identified and preliminarily validated.
  • This approach, targeting thalamic regions connected to premotor and supplementary motor cortices, may enhance DBS precision and efficacy over traditional methods.
  • Further prospective evaluation and development of accessible methodologies are warranted.