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A method for pre-operative single-subject thalamic segmentation based on probabilistic tractography for essential tremor deep brain stimulation

  • Functional Neuroradiology
  • Published:
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Abstract

Purpose

Deep brain stimulation is a common treatment for medication-refractory essential tremor. Current coordinate-based targeting methods result in variable outcomes due to variation in thalamic structure and the optimal patient-specific functional location. The purpose of this study was to compare the coordinate-based pre-operative targets to patient-specific thalamic segmentation utilizing a probabilistic tractography methodology.

Methods

Using available diffusion MRI of 32 subjects from the Human Connectome Project database, probabilistic tractography was performed. Each thalamic voxel was coded based on one of six predefined cortical targets. The segmentation results were analyzed and compared to a 2-mm spherical target centered at the coordinate-based location of the ventral intermediate thalamic nucleus.

Results

The traditional coordinate-based target had maximal overlap with the junction of the region most connected to primary motor cortex (M1) (36.6 ± 25.7% of voxels on left; 58.1 ± 28.5% on right) and the area connected to the supplementary motor area/premotor cortex (SMA/PMC) (44.9 ± 21.7% of voxels on left; 28.9 ± 22.2% on right). There was a within-subject coefficient of variation from right-to-left of 69.4 and 63.1% in the volume of overlap with the SMA/PMC and M1 regions, respectively.

Conclusion

Thalamic segmentation based on structural connectivity measures is a promising technique that may enhance traditional targeting methods by generating reproducible, patient-specific pre-operative functional targets. Our results highlight the problematic intra- and inter-subject variability of indirect, coordinate-based targets. Future prospective clinical studies will be needed to validate this targeting methodology in essential tremor patients.

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Abbreviations

ET:

Essential tremor

DBS:

Deep brain stimulator

Vim:

Ventral intermediate nucleus

Vo:

Ventralis oralis

PMC:

Premotor cortex

SMA:

Supplementary motor area

PFC:

Prefrontal cortex

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Acknowledgements

Data were provided in part by the Human Connectome Project, the WU-Minn Consortium (Principal Investigators: David Van Essen and Kamil Ugurbil; 1U54MH091657), funded by the 16 NIH Institutes and Centers that support the NIH Blueprint for Neuroscience Research, and by the McDonnell Center for Systems Neuroscience at Washington University.

Author information

Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL, 32224, USA

    Erik H. Middlebrooks

  2. Department of Neurosurgery, University of Florida, Gainesville, FL, USA

    Vanessa M. Holanda & Kelly D. Foote

  3. Center of Neurology and Neurosurgery Associates (CENNA), Beneficência Portuguesa of São Paulo Hospital, São Paulo, Brazil

    Vanessa M. Holanda

  4. Department of Radiology, University of Florida, Gainesville, FL, USA

    Ibrahim S. Tuna

  5. Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA

    Hrishikesh D. Deshpande

  6. Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA

    Markus Bredel

  7. Department of Neurology, University of Florida, Gainesville, FL, USA

    Leonardo Almeida & Michael S. Okun

  8. Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA

    Harrison C. Walker

  9. Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA

    Barton L. Guthrie

Authors
  1. Erik H. Middlebrooks
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  2. Vanessa M. Holanda
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  6. Leonardo Almeida
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  8. Barton L. Guthrie
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  9. Kelly D. Foote
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  10. Michael S. Okun
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Corresponding author

Correspondence to Erik H. Middlebrooks.

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Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study in accordance with the Human Connectome Project as part of the open source dataset utilized in this study.

Additional information

This study was presented as an oral presentation in abstract form at the 2017 American Society of Functional Neuroradiology meeting in October 2017.

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Middlebrooks, E.H., Holanda, V.M., Tuna, I.S. et al. A method for pre-operative single-subject thalamic segmentation based on probabilistic tractography for essential tremor deep brain stimulation. Neuroradiology 60, 303–309 (2018). https://doi.org/10.1007/s00234-017-1972-2

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  • DOI: https://doi.org/10.1007/s00234-017-1972-2

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