Letter to the Editor. Multiple sclerosis–related tremor and stereotactic radiosurgery

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  • 1 Kiawah Island, SC; and
  • | 2 Osage Beach, MO
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TO THE EDITOR: We read with interest the article by Raju et al.8 on stereotactic radiosurgery for medically refractory multiple sclerosis tremor (Raju SS, Niranjan A, Monaco EA III, et al: Sterotactic radiosurgery for medically refractory multiple sclerosis–related tremor. J Neurosurg 128:1214–1221, April 2018).

Historically, this neurosurgery was first described and performed by Spiegel and Wycis,10,11 followed by Narabayashi,6 Obrador,7 Riechert,9 and others, with satisfactory result. During the “down time” for functional stereotaxy, progress was being made in diagnosis and anatomical localization using CT and MRI.1,3,4 In the spring of 1985, my colleague Dr. Hill and I conferred with Dr. Latchaw at Pittsburgh Medical Center over thalamic and subthalamic localization5,12 for a patient with bilateral multiple sclerosis (MS), but who was most symptomatic in her dominant left brain for the right hand. In August 1985, a lesion with CT localization for a target in the left subthalamus as well as the ventrolateral thalamus was treated through a single burr hole. In both loci, the electrode was first passed to the left subthalamus for a radiofrequency (RF) lesion, and then withdrawn to the left thalamus to make the second RF lesion. There was MRI conformation of both loci. An excellent result was achieved. The right brain lesion clinically worsened. In the spring of 1986 a single, right-thalamic ventrolateral RF lesion was placed with poor result. A week later with re-imaging a single more lateral, superior, and posterior RF lesion was made with excellent result, and MRI confirmation. The patient’s neurological result remained good/excellent under my observation for the next nearly 5 years. This clinical case was published in Applied Neurophysiology2 by Dr. Gildenberg, the editor of the journal and my fellow resident at Temple Medicine; with the passing of Dr. Spiegel, Confinia Neurologica stopped publication. The above authors have done a very good job in helping these MS patients with this variable clinical and neuropathological affliction.

Disclosures

The authors report no conflict of interest.

References

  • 1

    Latchaw RE, Lunsford LD, Kennedy WH: Reformatted imaging to define intercommissural line for CT-guided stereotaxic functional neurosurgery. AJNR Am J Neuroradiol 6:429433, 1985

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  • 2

    Lehman RM, Hill RP: Computed-tomography-directed stereotaxis for movement disorder with postoperative magnetic resonance imaging conformation. Appl Neurophysiol 51:2128, 1988

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  • 3

    Leksell L, Herner T, Leksell D, Persson B, Lindquist: Visualization of stereotactic radiolesions by nuclear magnetic resonance. J Neurol Neurosurg Psychiatry 48:1920, 1985

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  • 4

    Lunsford LD: Stereotaxy and the role of CT in morphological and functional surgery of the human brain, in Latchaw RE (ed): Computed Tomography of the Head, Neck and Spine. Chicago: Yearbook, 1985, pp 743764

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  • 5

    Maxwell RE, Mollman HD, Lund G: Magnetic resonance directed stereotaxis in functional neurosurgery and neuro-oncology, in 55th AANS Annual Meeting. Rolling Meadows, IL: AANS, 1987

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  • 6

    Narabayashi H: Functional differentiation in and around the ventrolateral nucleus of the thalamus based on experience in human stereoencephalotomy. Johns Hopkins Med J 122:295300, 1968

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  • 7

    Obrador S, Dierssen G: Observations on the treatment of intentional and postural tremor by subcortical stereotaxic lesions. Confin Neurol 26:250253, 1965

  • 8

    Raju SS, Niranjan A, Monaco EA III, Flickinger JC, Lunsford LD: Stereotactic radiosurgery for medically refractory multiple sclerosis–related tremor. J Neurosurg 128:12141221, 2018

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  • 9

    Riechert T: Stereotactic Brain Operations: Methods, Clinical Aspects, Indications. Bern: Huber, 1980

  • 10

    Spiegel EA, Wycis HT: Stereoencephalotomy. Thalamotomy and Related Procedures. Part I. Methods and Stereotaxic Atlas of the Human Brain. New York: Grune & Stratton, 1952

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  • 11

    Spiegel EA, Wycis HT: Stereoencephalotomy. Part II. Clinical and Physiological Applications. New York: Grune & Stratton, 1962

  • 12

    Wyper DJ, Turner JW, Patterson J, Condon BR, Grossart KWM, Jenkins A, et al.: Accuracy of stereotactic localization using MRI and CT. J Neurol Neurosurg Psychiatry 49:14451448, 1986

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  • 1 University of Pittsburgh Medical Center, Pittsburgh, PA; and
  • | 2 University of Pittsburgh School of Medicine, Pittsburgh, PA

Response

We thank Drs. Lehman and Hill for their interest in our work. We greatly appreciated the historical vignette they provided. We also read with interest their initial personal experience with thalamic lesioning for a patient with MS-related tremor in 1985 and 5 years of follow-up. Drs. Lehman and Hill thoughtfully reference some of our early work from 33 years ago using CT to perform functional neurosurgery. In that era preceding MRI, many were resistant to using CT to target deep brain structures, relying even then on air or contrast encephalography to define standard stereotactic landmarks such as the anterior and posterior commissures. The advent and maturation of MRI finally gave us the means to better define these landmarks, as well as the internal capsule. Advanced MRI now allows us to perform thalamic segmentation and tractography in each patient preoperatively. We thank them for their encouraging comments.

  • 1

    Latchaw RE, Lunsford LD, Kennedy WH: Reformatted imaging to define intercommissural line for CT-guided stereotaxic functional neurosurgery. AJNR Am J Neuroradiol 6:429433, 1985

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Lehman RM, Hill RP: Computed-tomography-directed stereotaxis for movement disorder with postoperative magnetic resonance imaging conformation. Appl Neurophysiol 51:2128, 1988

    • Search Google Scholar
    • Export Citation
  • 3

    Leksell L, Herner T, Leksell D, Persson B, Lindquist: Visualization of stereotactic radiolesions by nuclear magnetic resonance. J Neurol Neurosurg Psychiatry 48:1920, 1985

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Lunsford LD: Stereotaxy and the role of CT in morphological and functional surgery of the human brain, in Latchaw RE (ed): Computed Tomography of the Head, Neck and Spine. Chicago: Yearbook, 1985, pp 743764

    • Search Google Scholar
    • Export Citation
  • 5

    Maxwell RE, Mollman HD, Lund G: Magnetic resonance directed stereotaxis in functional neurosurgery and neuro-oncology, in 55th AANS Annual Meeting. Rolling Meadows, IL: AANS, 1987

    • Search Google Scholar
    • Export Citation
  • 6

    Narabayashi H: Functional differentiation in and around the ventrolateral nucleus of the thalamus based on experience in human stereoencephalotomy. Johns Hopkins Med J 122:295300, 1968

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Obrador S, Dierssen G: Observations on the treatment of intentional and postural tremor by subcortical stereotaxic lesions. Confin Neurol 26:250253, 1965

  • 8

    Raju SS, Niranjan A, Monaco EA III, Flickinger JC, Lunsford LD: Stereotactic radiosurgery for medically refractory multiple sclerosis–related tremor. J Neurosurg 128:12141221, 2018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Riechert T: Stereotactic Brain Operations: Methods, Clinical Aspects, Indications. Bern: Huber, 1980

  • 10

    Spiegel EA, Wycis HT: Stereoencephalotomy. Thalamotomy and Related Procedures. Part I. Methods and Stereotaxic Atlas of the Human Brain. New York: Grune & Stratton, 1952

    • Search Google Scholar
    • Export Citation
  • 11

    Spiegel EA, Wycis HT: Stereoencephalotomy. Part II. Clinical and Physiological Applications. New York: Grune & Stratton, 1962

  • 12

    Wyper DJ, Turner JW, Patterson J, Condon BR, Grossart KWM, Jenkins A, et al.: Accuracy of stereotactic localization using MRI and CT. J Neurol Neurosurg Psychiatry 49:14451448, 1986

    • Crossref
    • Search Google Scholar
    • Export Citation

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