Thalamic deep brain stimulation for disabling tremor after excision of a midbrain cavernous angioma

Case report

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✓ Thalamic deep brain stimulation (DBS) has been demonstrated to be effective for the treatment of parkinsonian or essential tremor. To date, however, few data exist to support the application of this method to treat midbrain tremor.

A 24-year-old right-handed man underwent radiosurgery and subsequent resection of a recurrently hemorrhaging cavernous angioma located in the left side of the midbrain. The surgery exacerbated severe choreoathetotic resting and action tremors of his right extremities and trunk. The patient underwent placement of a deep brain stimulator into the left ventral intermediate nucleus of the thalamus (Vim). Postoperatively, decreased truncal ataxia and right-sided choreoathetotic tremor were demonstrated, with a 57% increase in dexterity as measured by task testing.

The authors demonstrate that DBS can be an effective treatment modality for disabling tremor after resection of a midbrain cavernous angioma.

Article Information

Address reprint requests to: Gordon H. Baltuch, M.D., Ph.D., Department of Neurosurgery, Penn Neurological Institute at Pennsylvania Hospital, 330 South Ninth Street, Philadelphia, Pennsylvania 19107. email: gordon.baltuch@uphs.upenn.edu.

© AANS, except where prohibited by US copyright law.

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    Postoperative MR image demonstrating a lesion on the left side of the midbrain after resection of a cavernous angioma. The DBS lead is located in the left Vim.

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