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Targeting the vim by direct visualization of the cerebello-thalamo-cortical pathway in 3 T proton density MRI: correlation with focused ultrasound lesioning

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Abstract

Surgical targeting of the ventral intermediate nucleus of the thalamus (VIM) has been historically done using indirect strategies. Here we depict the cerebello-thalamo-cortical tract (CTCT) through 3 T proton density (PD) in a cohort of patients who underwent high-intensity focus ultrasound (HIFUS) thalamotomy. Forty-seven patients treated in our institution with MR-guided HIFUS VIM thalamotomy were included in this study. PD weighted 3 T MRI used for presurgical planning was compared with postoperative MRI obtained 1 month after surgery. Images were processed with ISTX software (Brain lab, Munich, Germany). The coordinates of the VIM lesion concerning the inter-commissural line (ICL) were annotated. Deterministic tractographies using three ROIs were used to verify the different tracts. The triangle seen in the 3 T PD sequence at the level of the mesencephalic-diencephalic junction was systematically recognized. The posterior angle of this triangle at the junction of the CTCT and the ZI was denominated as “point P.” The area of this triangle corresponds to the posterior subthalamic area (PSA) harboring the Raprl fibers. The CTCT was visible from 1 to 2.5 mm below the ICL. The average center of the final HIFUS lesion (point F) was 11 mm from the medial thalamic border of the thalamus (14.9 mm from the midline), 6.4 mm anterior to PC, and 0.6 mm above the ICL. The FUS point was consistently 1–2 mm directly above point P. The anterior border of the external angle of this triangle (point P) can be used as an intraparenchymal point for targeting the ventral border of the VIM. Three ROIs placed in a single slice around this triangle are a fast way to originate tractography of the CTCT, lemniscus medialis, and pyramidal tract.

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Data availability

See supplementary contents to view the data for each patient and the imaging protocol employed in this study.

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Acknowledgements

We are indebted to the Social Medicine and Family Health Department. The University of Cauca, Popayan, Colombia, for its critical support methodological issues.

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Authors and Affiliations

  1. Functional Neurosurgery Unit, DepartmentofNeurosurgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel

    Maximiliano Páez-Nova, Roberto Spiegelmann & Zion Zibly

  2. The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Roberto Spiegelmann & Simon Korn-Israeli

  3. Abnormal Movements Unit, Department of Neurology, The Chaim Sheba Medical Center, Tel Hashomer, Israel

    Simon Korn-Israeli & Carmen Daza-Cordoba

  4. Social Medicine and Family Health Department, University of Cauca, Popayan, Colombia

    Diego Illera-Rivera

  5. Department of Electrical and Electronic Engineering, National University, Bogota, Colombia

    Juan Carlos Alcazar-Daza

  6. Center of Biomedical Research, Faculty of Medicine, University of Cartagena, Cartagena, Colombia

    Ezequiel Garcia-Ballestas

Authors
  1. Maximiliano Páez-Nova
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  2. Roberto Spiegelmann
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  3. Simon Korn-Israeli
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  4. Zion Zibly
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  5. Diego Illera-Rivera
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  6. Carmen Daza-Cordoba
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  8. Ezequiel Garcia-Ballestas
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Contributions

Concept and design: Paez and Spiegelmann. Data acquisition: Paez, Korn, and Zibly. Article draft: Paez. Critical review: Spielgelmann, Paez, and Garcia. Epidemiological advice: Daza. Statistical analysis: Illera and Alcazar. Study supervision: Spiegelmann and Garcia.

Corresponding authors

Correspondence to Maximiliano Páez-Nova or Roberto Spiegelmann.

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For this retrospective study, an approval was granted by the institutional review board (IRB).

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All authors have previously acknowledged for the publication of this article in Neurosurgical Review.

Conflict of interest

The senior author (RS) has served as a consultant to Brainlab. The other authors have no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Páez-Nova, M., Spiegelmann, R., Korn-Israeli, S. et al. Targeting the vim by direct visualization of the cerebello-thalamo-cortical pathway in 3 T proton density MRI: correlation with focused ultrasound lesioning. Neurosurg Rev 45, 2323–2332 (2022). https://doi.org/10.1007/s10143-022-01752-0

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