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11.11.2017 | Original Article - Functional | Ausgabe 3/2018

Acta Neurochirurgica 3/2018

Right Brodmann area 18 predicts tremor arrest after Vim radiosurgery: a voxel-based morphometry study

Zeitschrift:
Acta Neurochirurgica > Ausgabe 3/2018
Autoren:
Constantin Tuleasca, Tatiana Witjas, Dimitri Van de Ville, Elena Najdenovska, Antoine Verger, Nadine Girard, Jerome Champoudry, Jean-Philippe Thiran, Meritxell Bach Cuadra, Marc Levivier, Eric Guedj, Jean Régis
Wichtige Hinweise
Tatiana Witjas, Dimitri Van de Ville, Eric Guedj and Jean Régis contributed equally to the present study

Comments

Fifty-two patients with right-sided ET were treated with left unilateral Vim Gamma Knife (Vim) thalamotomy. Targeting was performed using 130 Gy and a single 4-mm collimator. Pre-therapeutic gray matter density in T1-weighted MRI (GMD) was correlated with tremor score improvement of the treated hand (TSTH) at 1 year after Vim RS as a continuous variable. As the only statistically significant anatomical region, higher baseline GMD in right Brodmann area 18 (visual association area V2) correlated with better TSTH improvement.
This article shows a very interesting relation between unsuspected anatomical visual association areas (BA18, V2) and tremor arrest in general by demonstrating a correlation between pre-therapeutic T1w imaging in visual association areas and outcome of left unilateral radiosurgical Vim lesions in patients with right-sided essential tremor.
Bodo Lippitz
Hamburg, Germany
This study is from a leading group in the field of radiosurgery for functional disorders. The authors were able to recruit a remarkable number of patients treated with an innovative method for a rare disease. No a priori hypothesis was used in the statistical model, which is a very important strength of the study. Also, the hypothesis that the visual areas are linked to the motor ones, as sensory guidance of the movement of the hand and fingers, appears sound and sheds new light on the understanding of the visuospatial network.
Alfredo Conti
Messina, Italy

Abstract

Introduction

Drug-resistant essential tremor (ET) can benefit from open standard stereotactic procedures, such as deep-brain stimulation or radiofrequency thalamotomy. Non-surgical candidates can be offered either high-focused ultrasound (HIFU) or radiosurgery (RS). All procedures aim to target the same thalamic site, the ventro-intermediate nucleus (e.g., Vim). The mechanisms by which tremor stops after Vim RS or HIFU remain unknown. We used voxel-based morphometry (VBM) on pretherapeutic neuroimaging data and assessed which anatomical site would best correlate with tremor arrest 1 year after Vim RS.

Methods

Fifty-two patients (30 male, 22 female; mean age 71.6 years, range 49–82) with right-sided ET benefited from left unilateral Vim RS in Marseille, France. Targeting was performed in a uniform manner, using 130 Gy and a single 4-mm collimator. Neurological (pretherapeutic and 1 year after) and neuroimaging (baseline) assessments were completed. Tremor score on the treated hand (TSTH) at 1 year after Vim RS was included in a statistical parametric mapping analysis of variance (ANOVA) model as a continuous variable with pretherapeutic neuroimaging data. Pretherapeutic gray matter density (GMD) was further correlated with TSTH improvement. No a priori hypothesis was used in the statistical model.

Results

The only statistically significant region was right Brodmann area (BA) 18 (visual association area V2, p = 0.05, cluster size Kc = 71). Higher baseline GMD correlated with better TSTH improvement at 1 year after Vim RS (Spearman’s rank correlation coefficient = 0.002).

Conclusions

Routine baseline structural neuroimaging predicts TSTH improvement 1 year after Vim RS. The relevant anatomical area is the right visual association cortex (BA 18, V2). The question whether visual areas should be included in the targeting remains open.

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