Direct targeting of the ventral intermediate nucleus of the thalamus in deep brain stimulation for essential tremor: a prospective study with comparison to a historical cohort

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  • 1 Department of Medical Education, Creighton University School of Medicine, Phoenix;
  • | 2 Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix; and
  • | 3 Movement Disorders Center of Arizona, Scottsdale, Arizona
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OBJECTIVE

The ventral intermediate nucleus of the thalamus (VIM) is an effective target for deep brain stimulation (DBS) to control symptoms related to essential tremor. The VIM is typically targeted using indirect methods, although studies have reported visualization of the VIM on proton density–weighted MRI. This study compares the outcomes between patients who underwent VIM DBS with direct and indirect targeting.

METHODS

Between August 2013 and December 2019, 230 patients underwent VIM DBS at the senior author’s institution. Of these patients, 92 had direct targeting (direct visualization on proton density 3-T MRI). The remaining 138 patients had indirect targeting (relative to the third ventricle and anterior commissure–posterior commissure line).

RESULTS

Coordinates of electrodes placed with direct targeting were significantly more lateral (p < 0.001) and anterior (p < 0.001) than those placed with indirect targeting. The optimal stimulation amplitude for devices measured in voltage was lower for those who underwent direct targeting than for those who underwent indirect targeting (p < 0.001). Patients undergoing direct targeting had a greater improvement only in their Quality of Life in Essential Tremor Questionnaire hobby score versus those undergoing indirect targeting (p = 0.04). The direct targeting group had substantially more symptomatic hemorrhages than the indirect targeting group (p = 0.04). All patients who experienced a postoperative hemorrhage after DBS recovered without intervention.

CONCLUSIONS

Patients who underwent direct VIM targeting for DBS treatment of essential tremor had similar clinical outcomes to those who underwent indirect targeting. Direct VIM targeting is safe and effective.

ABBREVIATIONS

AC-PC = anterior commissure–posterior commissure; ADL = activities of daily living; AMS = altered mental status; BFTADL = Bain and Finley Tremor Activities of Daily Living; DBS = deep brain stimulation; ET = essential tremor; LOS = length of stay; QUEST = Quality of Life in Essential Tremor Questionnaire; VIM = ventral intermediate nucleus of the thalamus.

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  • 1

    Perlmutter JS, Mink JW. Deep brain stimulation. Annu Rev Neurosci. 2006;29:229257.

  • 2

    Diamond A, Jankovic J. The effect of deep brain stimulation on quality of life in movement disorders. J Neurol Neurosurg Psychiatry. 2005;76(9):11881193.

    • Search Google Scholar
    • Export Citation
  • 3

    Hariz GM, Blomstedt P, Koskinen LO. Long-term effect of deep brain stimulation for essential tremor on activities of daily living and health-related quality of life. Acta Neurol Scand. 2008;118(6):387394.

    • Search Google Scholar
    • Export Citation
  • 4

    Krack P, Volkmann J, Tinkhauser G, Deuschl G. Deep brain stimulation in movement disorders: from experimental surgery to evidence-based therapy. Mov Disord. 2019;34(12):17951810.

    • Search Google Scholar
    • Export Citation
  • 5

    Halpern C, Hurtig H, Jaggi J, et al. Deep brain stimulation in neurologic disorders. Parkinsonism Relat Disord. 2007;13(1):116.

  • 6

    Agarwal N. Neurosurgery Fundamentals. 1st ed. Thieme;2018.

  • 7

    Chopra A, Klassen BT, Stead M. Current clinical application of deep-brain stimulation for essential tremor. Neuropsychiatr Dis Treat. 2013;9:18591865.

    • Search Google Scholar
    • Export Citation
  • 8

    Lyons KE, Pahwa R. Deep brain stimulation and tremor. Neurotherapeutics. 2008;5(2):331338.

  • 9

    Harary M, Segar DJ, Hayes MT, Cosgrove GR. Unilateral thalamic deep brain stimulation versus focused ultrasound thalamotomy for essential tremor. World Neurosurg. 2019;126:e144e152.

    • Search Google Scholar
    • Export Citation
  • 10

    Chen T, Mirzadeh Z, Chapple K, et al. "Asleep" deep brain stimulation for essential tremor. J Neurosurg. 2016;124(6):18421849.

  • 11

    Pouratian N, Zheng Z, Bari AA, et al. Multi-institutional evaluation of deep brain stimulation targeting using probabilistic connectivity-based thalamic segmentation. J Neurosurg. 2011;115(5):9951004.

    • Search Google Scholar
    • Export Citation
  • 12

    Najdenovska E, Tuleasca C, Jorge J, et al. Comparison of MRI-based automated segmentation methods and functional neurosurgery targeting with direct visualization of the Ventro-intermediate thalamic nucleus at 7T. Sci Rep. 2019;9(1):1119.

    • Search Google Scholar
    • Export Citation
  • 13

    Fenoy AJ, Schiess MC. Deep brain stimulation of the dentato-rubro-thalamic tract: outcomes of direct targeting for tremor. Neuromodulation. 2017;20(5):429436.

    • Search Google Scholar
    • Export Citation
  • 14

    Spiegelmann R, Nissim O, Daniels D, et al. Stereotactic targeting of the ventrointermediate nucleus of the thalamus by direct visualization with high-field MRI. Stereotact Funct Neurosurg. 2006;84(1):1923.

    • Search Google Scholar
    • Export Citation
  • 15

    Sidiropoulos C, Mubita L, Krstevska S, Schwalb JM. Successful Vim targeting for mixed essential and parkinsonian tremor using intraoperative MRI. J Neurol Sci. 2015;358(1-2):488489.

    • Search Google Scholar
    • Export Citation
  • 16

    Vassal F, Coste J, Derost P, et al. Direct stereotactic targeting of the ventrointermediate nucleus of the thalamus based on anatomic 1.5-T MRI mapping with a white matter attenuated inversion recovery (WAIR) sequence. Brain Stimul. 2012;5(4):625633.

    • Search Google Scholar
    • Export Citation
  • 17

    Chen T, Mirzadeh Z, Chapple KM, et al. Intraoperative test stimulation versus stereotactic accuracy as a surgical end point: a comparison of essential tremor outcomes after ventral intermediate nucleus deep brain stimulation. J Neurosurg. 2018;129(2):290298.

    • Search Google Scholar
    • Export Citation
  • 18

    King NKK, Krishna V, Sammartino F, et al. Anatomic targeting of the optimal location for thalamic deep brain stimulation in patients with essential tremor. World Neurosurg. 2017;107:168174.

    • Search Google Scholar
    • Export Citation
  • 19

    Mirzadeh Z, Chapple K, Lambert M, et al. Validation of CT-MRI fusion for intraoperative assessment of stereotactic accuracy in DBS surgery. Mov Disord. 2014;29(14):17881795.

    • Search Google Scholar
    • Export Citation
  • 20

    Koller WC, Lyons KE, Wilkinson SB, Pahwa R. Efficacy of unilateral deep brain stimulation of the VIM nucleus of the thalamus for essential head tremor. Mov Disord. 1999;14(5):847850.

    • Search Google Scholar
    • Export Citation
  • 21

    Zhang K, Bhatia S, Oh MY, et al. Long-term results of thalamic deep brain stimulation for essential tremor. J Neurosurg. 2010;112(6):12711276.

    • Search Google Scholar
    • Export Citation
  • 22

    Sandoe C, Krishna V, Basha D, et al. Predictors of deep brain stimulation outcome in tremor patients. Brain Stimul. 2018;11(3):592599.

  • 23

    Holslag JAH, Neef N, Beudel M, et al. Deep brain stimulation for essential tremor: a comparison of targets. World Neurosurg. 2018;110:e580e584.

    • Search Google Scholar
    • Export Citation
  • 24

    Louis ED, Dogu O. Does age of onset in essential tremor have a bimodal distribution? Data from a tertiary referral setting and a population-based study. Neuroepidemiology. 2007;29(3-4):208212.

    • Search Google Scholar
    • Export Citation
  • 25

    Chen T, Mirzadeh Z, Chapple K, et al. Complication rates, lengths of stay, and readmission rates in “awake” and “asleep” deep brain simulation. J Neurosurg. 2017;127(2):360369.

    • Search Google Scholar
    • Export Citation
  • 26

    King NKK, Krishna V, Basha D, et al. Microelectrode recording findings within the tractography-defined ventral intermediate nucleus. J Neurosurg. 2017;126(5):16691675.

    • Search Google Scholar
    • Export Citation
  • 27

    Fenoy AJ, Schiess MC. Comparison of tractography-assisted to atlas-based targeting for deep brain stimulation in essential tremor. Mov Disord. 2018;33(12):18951901.

    • Search Google Scholar
    • Export Citation
  • 28

    Putzke JD, Uitti RJ, Obwegeser AA, et al. Bilateral thalamic deep brain stimulation: midline tremor control. J Neurol Neurosurg Psychiatry. 2005;76(5):684690.

    • Search Google Scholar
    • Export Citation
  • 29

    Falowski SM, Bakay RAE. Revision surgery of deep brain stimulation leads. Neuromodulation. 2016;19(5):443450.

  • 30

    Xiaowu H, Xiufeng J, Xiaoping Z, et al. Risks of intracranial hemorrhage in patients with Parkinson’s disease receiving deep brain stimulation and ablation. Parkinsonism Relat Disord. 2010;16(2):96100.

    • Search Google Scholar
    • Export Citation
  • 31

    Fenoy AJ, Simpson RK Jr. Risks of common complications in deep brain stimulation surgery: management and avoidance. J Neurosurg. 2014;120(1):132139.

    • Search Google Scholar
    • Export Citation
  • 32

    Park JH, Chung SJ, Lee CS, Jeon SR. Analysis of hemorrhagic risk factors during deep brain stimulation surgery for movement disorders: comparison of the circumferential paired and multiple electrode insertion methods. Acta Neurochir (Wien). 2011;153(8):15731578.

    • Search Google Scholar
    • Export Citation
  • 33

    Binder DK, Rau G, Starr PA. Hemorrhagic complications of microelectrode-guided deep brain stimulation. Stereotact Funct Neurosurg. 2003;80(1-4):2831.

    • Search Google Scholar
    • Export Citation
  • 34

    Terao T, Takahashi H, Yokochi F, et al. Hemorrhagic complication of stereotactic surgery in patients with movement disorders. J Neurosurg. 2003;98(6):12411246.

    • Search Google Scholar
    • Export Citation

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