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Acta Neurochir (Wien). 2017 Nov;159(11):2139-2144. doi: 10.1007/s00701-017-3317-7. Epub 2017 Sep 23.

Assessing the clinical outcome of Vim radiosurgery with voxel-based morphometry: visual areas are linked with tremor arrest!

Author information

1
Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 44-46, BH-08, CH-1011, Lausanne, Switzerland. constantin.tuleasca@gmail.com.
2
Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland. constantin.tuleasca@gmail.com.
3
Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland. constantin.tuleasca@gmail.com.
4
Department of Neurology and Movement Disorders, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Timone University Hospital, Marseille, France.
5
Institut de Neurosciences de la Timone, UMR 7289, CNRS Aix-Marseille Université, Marseille, France.
6
Radiology Department, Center for Biomedical Imaging (CIBM), Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
7
Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Timone University Hospital, France;Institut de Neurosciences de la Timone, UMR 7289, CNRS Aix-Marseille Université, CERIMED, Aix-Marseille Université, Marseille, France.
8
Department of Diagnostic and Interventionnal Neuroradiology, AMU, CRMBM UMR CNRS 7339, Faculté de Médecine et APHM, Hopital Timone, Marseille, France.
9
Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, CHU Timone, Marseille, France.
10
Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
11
Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
12
Medical Image Processing Laboratory, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
13
Faculty of Medicine, University of Geneva, Geneva, Switzerland.
14
Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 44-46, BH-08, CH-1011, Lausanne, Switzerland.

Abstract

INTRODUCTION:

Radiosurgery (RS) is an alternative to open standard stereotactic procedures (deep-brain stimulation or radiofrequency thalamotomy) for drug-resistant essential tremor (ET), aiming at the same target (ventro-intermediate nucleus, Vim). We investigated the Vim RS outcome using voxel-based morphometry by evaluating the interaction between clinical response and time.

METHODS:

Thirty-eight patients with right-sided ET benefited from left unilateral Vim RS. Targeting was performed using 130 Gy and a single 4-mm collimator. Neurological and neuroimaging assessment was completed at baseline and 1 year. Clinical responders were considered those with at least 50% improvement in tremor score on the treated hand (TSTH).

RESULTS:

Interaction between clinical response and time showed the left temporal pole and occipital cortex (Brodmann area 19, including V4, V5 and the parahippocampal place area) as statistically significant. A decrease in gray matter density (GMD) 1 year after Vim RS correlated with higher TSTH improvement (Spearman = 0.01) for both anatomical areas. Higher baseline GMD within the left temporal pole correlated with better TSTH improvement (Spearman = 0.004).

CONCLUSIONS:

Statistically significant structural changes in the relationship to clinical response after Vim RS are present in remote areas, advocating a distant neurobiological effect. The former regions are mainly involved in locomotor monitoring toward the local and distant environment, suggesting the recruiting requirement in targeting of the specific visuomotor networks.

KEYWORDS:

Gamma Knife surgery; Radiosurgery; Thalamotomy; Tremor; Ventro-intermediate nucleus; Voxel-based morphometry

PMID:
28942466
DOI:
10.1007/s00701-017-3317-7
[Indexed for MEDLINE]

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