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

  • Original Article - Functional
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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.

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Funding

This work has been supported by the Timone University Hospital, the Swiss National Science Foundation SNSF-205321-157,040, the Centre d’Imagerie BioMédicale (CIBM) of the University of Lausanne (UNIL), the University of Geneva (UniGe), the Centre Hospitalier Universitaire Vaudois (CHUV) and the Leenaards and Jeantet Foundations. This work was carried out thanks to the support of the A*MIDEX project (no. ANR-11-IDEX-0001-02) funded by the “Investissements d’Avenir” French Government program, managed by the French National Research Agency (ANR).

Author information

Author notes

  1. Eric Guedj and Jean Régis equally contributed to the present study.

Authors and Affiliations

  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 & Marc Levivier

  2. Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland

    Constantin Tuleasca & Jean-Philippe Thiran

  3. Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland

    Constantin Tuleasca, Jean-Philippe Thiran & Marc Levivier

  4. Department of Neurology and Movement Disorders, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Timone University Hospital, Marseille, France

    Tatiana Witjas

  5. Institut de Neurosciences de la Timone, UMR 7289, CNRS Aix-Marseille Université, Marseille, France

    Tatiana Witjas

  6. Radiology Department, Center for Biomedical Imaging (CIBM), Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    Elena Najdenovska & Meritxell Bach Cuadra

  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

    Antoine Verger & Eric Guedj

  8. Department of Diagnostic and Interventionnal Neuroradiology, AMU, CRMBM UMR CNRS 7339, Faculté de Médecine et APHM, Hopital Timone, Marseille, France

    Nadine Girard

  9. Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, CHU Timone, Marseille, France

    Jerome Champoudry & Jean Régis

  10. Medical Image Processing Laboratory, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland

    Dimitri Van de Ville

  11. Faculty of Medicine, University of Geneva, Geneva, Switzerland

    Dimitri Van de Ville

Authors
  1. Constantin Tuleasca
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  2. Tatiana Witjas
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  3. Elena Najdenovska
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  4. Antoine Verger
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  5. Nadine Girard
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  6. Jerome Champoudry
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  7. Jean-Philippe Thiran
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  8. Dimitri Van de Ville
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  9. Meritxell Bach Cuadra
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  10. Marc Levivier
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  11. Eric Guedj
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  12. Jean Régis
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Corresponding author

Correspondence to Constantin Tuleasca.

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Conflicts of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

The study was approved by the local ethics committee of Timone University Hospital, Marseille, France.

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Tuleasca, C., Witjas, T., Najdenovska, E. et al. Assessing the clinical outcome of Vim radiosurgery with voxel-based morphometry: visual areas are linked with tremor arrest!. Acta Neurochir 159, 2139–2144 (2017). https://doi.org/10.1007/s00701-017-3317-7

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  • DOI: https://doi.org/10.1007/s00701-017-3317-7

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