Acta Neurochirurgica

, Volume 159, Issue 11, pp 2139–2144 | Cite as

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

  • Constantin TuleascaEmail author
  • Tatiana Witjas
  • Elena Najdenovska
  • Antoine Verger
  • Nadine Girard
  • Jerome Champoudry
  • Jean-Philippe Thiran
  • Dimitri Van de Ville
  • Meritxell Bach Cuadra
  • Marc Levivier
  • Eric Guedj
  • Jean Régis
Original Article - Functional



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.


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).


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).


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.


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



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).

Compliance with ethical standards

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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Copyright information

© Springer-Verlag GmbH Austria 2017

Authors and Affiliations

  • Constantin Tuleasca
    • 1
    • 2
    • 3
    Email author
  • Tatiana Witjas
    • 4
    • 5
  • Elena Najdenovska
    • 6
  • Antoine Verger
    • 7
  • Nadine Girard
    • 8
  • Jerome Champoudry
    • 9
  • Jean-Philippe Thiran
    • 2
    • 3
  • Dimitri Van de Ville
    • 10
    • 11
  • Meritxell Bach Cuadra
    • 6
  • Marc Levivier
    • 1
    • 3
  • Eric Guedj
    • 7
  • Jean Régis
    • 9
  1. 1.Neurosurgery Service and Gamma Knife CenterCentre Hospitalier Universitaire Vaudois (CHUV)LausanneSwitzerland
  2. 2.Signal Processing Laboratory (LTS 5)Ecole Polytechnique Fédérale de Lausanne (EPFL)LausanneSwitzerland
  3. 3.Faculty of Biology and MedicineUniversity of LausanneLausanneSwitzerland
  4. 4.Department of Neurology and Movement Disorders, Assistance Publique-Hôpitaux de MarseilleAix-Marseille Université, Timone University HospitalMarseilleFrance
  5. 5.Institut de Neurosciences de la Timone, UMR 7289, CNRS Aix-Marseille UniversitéMarseilleFrance
  6. 6.Radiology Department, Center for Biomedical Imaging (CIBM)Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Centre Hospitalier Universitaire VaudoisLausanneSwitzerland
  7. 7.Department of Nuclear Medicine, Assistance Publique-Hôpitaux de MarseilleAix-Marseille Université, Timone University Hospital, France;Institut de Neurosciences de la Timone, UMR 7289, CNRS Aix-Marseille Université, CERIMED, Aix-Marseille UniversitéMarseilleFrance
  8. 8.Department of Diagnostic and Interventionnal NeuroradiologyAMU, CRMBM UMR CNRS 7339, Faculté de Médecine et APHM, Hopital TimoneMarseilleFrance
  9. 9.Stereotactic and Functional Neurosurgery Service and Gamma Knife UnitCHU TimoneMarseilleFrance
  10. 10.Medical Image Processing LaboratoryEcole Polytechnique Fédérale de Lausanne (EPFL)LausanneSwitzerland
  11. 11.Faculty of MedicineUniversity of GenevaGenevaSwitzerland

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