Targeting the posterior subthalamic area for essential tremor: proposal for MRI-based anatomical landmarks

Area of Science:

• Neurosurgery
• Neurology
• Medical Imaging

Background:

• Deep brain stimulation (DBS) of the posterior subthalamic area (PSA) is an alternative to thalamic DBS for essential tremor (ET).
• The dentato-rubro-thalamic tract (DRTT) is implicated in effective DBS for ET.
• Diffusion tensor imaging (DTI)-based tractography for DRTT depiction has limitations.

Purpose of the Study:

• To present an accurate targeting strategy for PSA DBS using MRI-based anatomical landmarks.
• To evaluate the clinical effectiveness of this targeting strategy for essential tremor.

Main Methods:

• Retrospective cohort study of 11 ET patients undergoing bilateral PSA DBS.
• Used subthalamic nucleus and red nucleus as anatomical landmarks on 3-T T2-weighted MRI for target identification.
• Assessed outcomes using Tremor Rating Scale (TRS) scores at 6 and 12 months post-surgery.

Main Results:

• Targeting based on anatomical landmarks resulted in accurate lead placement.
• Significant reduction in total TRS scores (47.2 to 21.3, p < 0.001).
• No severe complications were reported.

Conclusions:

• MRI-based anatomical landmark targeting for PSA DBS is reliable for essential tremor.
• This strategy leads to accurate lead placement and favorable long-term clinical outcomes.