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Right Brodmann area 18 predicts tremor arrest after Vim radiosurgery: a voxel-based morphometry study

Authors
  • Tuleasca, Constantin
  • Witjas, Tatiana
  • Van de Ville, Dimitri
  • Najdenovska, Elena
  • Verger, Antoine
  • Girard, Nadine
  • Champoudry, Jerome
  • Thiran, Jean-Philippe
  • Cuadra, Meritxell Bach
  • Levivier, Marc
  • Guedj, Eric
  • Régis, Jean
Type
Published Article
Journal
Acta Neurochirurgica
Publisher
Springer-Verlag
Publication Date
Nov 11, 2017
Volume
160
Issue
3
Pages
603–609
Identifiers
DOI: 10.1007/s00701-017-3391-x
Source
Springer Nature
Keywords
License
Yellow

Abstract

IntroductionDrug-resistant essential tremor (ET) can benefit from open standard stereotactic procedures, such as deep-brain stimulation or radiofrequency thalamotomy. Non-surgical candidates can be offered either high-focused ultrasound (HIFU) or radiosurgery (RS). All procedures aim to target the same thalamic site, the ventro-intermediate nucleus (e.g., Vim). The mechanisms by which tremor stops after Vim RS or HIFU remain unknown. We used voxel-based morphometry (VBM) on pretherapeutic neuroimaging data and assessed which anatomical site would best correlate with tremor arrest 1 year after Vim RS.MethodsFifty-two patients (30 male, 22 female; mean age 71.6 years, range 49–82) with right-sided ET benefited from left unilateral Vim RS in Marseille, France. Targeting was performed in a uniform manner, using 130 Gy and a single 4-mm collimator. Neurological (pretherapeutic and 1 year after) and neuroimaging (baseline) assessments were completed. Tremor score on the treated hand (TSTH) at 1 year after Vim RS was included in a statistical parametric mapping analysis of variance (ANOVA) model as a continuous variable with pretherapeutic neuroimaging data. Pretherapeutic gray matter density (GMD) was further correlated with TSTH improvement. No a priori hypothesis was used in the statistical model.ResultsThe only statistically significant region was right Brodmann area (BA) 18 (visual association area V2, p = 0.05, cluster size Kc = 71). Higher baseline GMD correlated with better TSTH improvement at 1 year after Vim RS (Spearman’s rank correlation coefficient = 0.002).ConclusionsRoutine baseline structural neuroimaging predicts TSTH improvement 1 year after Vim RS. The relevant anatomical area is the right visual association cortex (BA 18, V2). The question whether visual areas should be included in the targeting remains open.

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