Technical Issues of Vim-PSA Double-Target DBS for Essential Tremor.

Area of Science:

• Neurosurgery
• Neurology
• Medical Devices

Background:

• Deep brain stimulation (DBS) is a key surgical treatment for essential tremor (ET).
• Common DBS targets for ET include the ventral intermediate nucleus (Vim) and posterior subthalamic area (PSA).
• Previous studies indicate the efficacy of dual-target Vim-PSA DBS for ET.

Purpose of the Study:

• To propose and detail surgical techniques for Vim-PSA dual-target DBS in essential tremor patients.
• To optimize electrode implantation accuracy and reduce procedural complications.

Main Methods:

• Six ET patients underwent Vim-PSA dual-target electrode implantation.
• Multimodality MRI and stereotactic guidance were used for precise target localization and burr hole drilling.
• Novel techniques like "arachnoid piamater welding" and "water sealing" were employed to minimize pneumocephalus.
• Intraoperative electrophysiological recording confirmed electrode placement.

Main Results:

• Accurate alignment of Vim and PSA targets was achieved using integrated imaging and coordinate data.
• Postoperative CT confirmed precise electrode implantation.
• "Arachnoid piamater welding" and "water sealing" effectively reduced pneumocephalus.
• Intraoperative electrophysiology validated the efficacy of the dual-target DBS approach.

Conclusions:

• Precise target localization, accurate burr hole drilling, pneumocephalus reduction, and electrophysiological verification are critical for successful Vim-PSA DBS.
• These surgical techniques offer valuable technical guidance for Vim-PSA DBS, particularly for less experienced functional neurosurgeons.