Thalamic stimulation for tremor: can target determination be improved?
Identifieur interne : 000021 ( Hal/Checkpoint ); précédent : 000020; suivant : 000022Thalamic stimulation for tremor: can target determination be improved?
Auteurs : Eric Bardinet [France] ; Hayat Belaid [France] ; David Grabli [France] ; Marie-Laure Welter [France] ; Sara Fernandez Vidal ; Damien Galanaud [France] ; Stéphane Derrey [France] ; Didier Dormont [France] ; Philippe Cornu [France] ; Jérôme Yelnik [France] ; Carine Karachi [France]Source :
- Movement Disorders [ 0885-3185 ] ; 2011-02-01.
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Abstract
High frequency stimulation of the ventral intermedius nucleus (Vim) of the thalamus is successfully used for the treatment of postural tremor. Target coordinates are most commonly calculated using a statistical method. Here, we compare a statistical and an individual targeting method, using an histology-based three-dimensional deformable brain atlas which allows localization of the Vim on individual patient's MR images by adaptation of the atlas onto the patient's brain. Twenty-nine consecutive patients had electrodes implanted in the Vim uni-or bilaterally for severe essential tremor. Thirty-five targets were determined by calculating the statistical target and then using the deformable atlas to compute the individual target. Pythagorean distance between these targets was calculated. Statistical and individual targets were compared by double blind evaluation of perioperative stimulation effects. For most cases (n = 24), the Pythagorean distance was higher than 1.5 mm. In 79% of these cases, the definitive electrode was implanted using the position of the individual target. For the remaining cases (n = 11, distance < 1.5 mm), the definitive electrode was implanted according to the statistical target location in 73% of the cases. As a whole, when individual target was used, it was located at least 2 mm more medial than the statistical one in 86% cases. These results suggest that Vim target determination based on a statistical method might be inaccurate. In particular, laterality might be overestimated, leading to nonoptimal clinical results. In clinical practice, this means that microelectrode exploration during Vim surgery should include at least one trajectory more medial than the statistical target.
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DOI: 10.1002/mds.23448
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Paris 6</orgName><orgName type="acronym">UPMC</orgName><desc><address><addrLine>4 place Jussieu - 75005 Paris</addrLine><country key="FR"></country></address><ref type="url">http://www.upmc.fr/</ref></desc></org></tutelle><tutelle name="U975" active="#struct-300002" type="direct"><org type="institution" xml:id="struct-300002" status="VALID"><orgName>INSERM</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle><tutelle name="UMR7225" active="#struct-441569" type="direct"><org type="institution" xml:id="struct-441569" status="VALID"><idno type="IdRef">02636817X</idno><idno type="ISNI">0000000122597504</idno><orgName>Centre National de la Recherche Scientifique</orgName><orgName type="acronym">CNRS</orgName><date type="start">1939-10-19</date><desc><address><country key="FR"></country></address><ref type="url">http://www.cnrs.fr/</ref></desc></org></tutelle></tutelles></hal:affiliation><country>France</country></affiliation></author><author><name sortKey="Welter, Marie Laure" sort="Welter, Marie Laure" uniqKey="Welter M" first="Marie-Laure" last="Welter">Marie-Laure Welter</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-81470" status="OLD"><orgName>Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière [Paris]</orgName><orgName type="acronym">CRICM</orgName><desc><address><addrLine>GH Pitié-Salpêtrière 47, boulevard de l'Hôpital 75651 Paris cedex 13</addrLine><country key="FR"></country></address><ref type="url">http://www.cricm.upmc.fr/</ref></desc><listRelation><relation active="#struct-93591" type="direct"></relation><relation name="U975" active="#struct-300002" type="direct"></relation><relation name="UMR7225" active="#struct-441569" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-93591" type="direct"><org type="institution" xml:id="struct-93591" status="VALID"><orgName>Université Pierre et Marie Curie - Paris 6</orgName><orgName type="acronym">UPMC</orgName><desc><address><addrLine>4 place Jussieu - 75005 Paris</addrLine><country key="FR"></country></address><ref type="url">http://www.upmc.fr/</ref></desc></org></tutelle><tutelle name="U975" active="#struct-300002" type="direct"><org type="institution" xml:id="struct-300002" status="VALID"><orgName>INSERM</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle><tutelle name="UMR7225" active="#struct-441569" type="direct"><org type="institution" xml:id="struct-441569" status="VALID"><idno type="IdRef">02636817X</idno><idno type="ISNI">0000000122597504</idno><orgName>Centre National de la Recherche Scientifique</orgName><orgName type="acronym">CNRS</orgName><date type="start">1939-10-19</date><desc><address><country key="FR"></country></address><ref type="url">http://www.cnrs.fr/</ref></desc></org></tutelle></tutelles></hal:affiliation><country>France</country></affiliation></author><author><name sortKey="Vidal, Sara Fernandez" sort="Vidal, Sara Fernandez" uniqKey="Vidal S" first="Sara Fernandez" last="Vidal">Sara Fernandez Vidal</name></author><author><name sortKey="Galanaud, Damien" sort="Galanaud, Damien" uniqKey="Galanaud D" first="Damien" last="Galanaud">Damien Galanaud</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-218549" status="OLD"><orgName>Equipe NEMESIS - Centre de Recherches de l'Institut du Cerveau et de la Moelle épinière</orgName><orgName type="acronym">NEMESIS-CRICM</orgName><desc><address><addrLine>47 boulevard de l'hôpital 75013 Paris</addrLine><country key="FR"></country></address></desc><listRelation><relation active="#struct-93591" type="direct"></relation><relation name="U975" active="#struct-300002" type="direct"></relation><relation name="UMR7225" active="#struct-441569" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-93591" type="direct"><org type="institution" xml:id="struct-93591" status="VALID"><orgName>Université Pierre et Marie Curie - Paris 6</orgName><orgName type="acronym">UPMC</orgName><desc><address><addrLine>4 place Jussieu - 75005 Paris</addrLine><country key="FR"></country></address><ref type="url">http://www.upmc.fr/</ref></desc></org></tutelle><tutelle name="U975" active="#struct-300002" type="direct"><org type="institution" xml:id="struct-300002" status="VALID"><orgName>INSERM</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle><tutelle name="UMR7225" active="#struct-441569" type="direct"><org type="institution" xml:id="struct-441569" status="VALID"><idno type="IdRef">02636817X</idno><idno type="ISNI">0000000122597504</idno><orgName>Centre National de la Recherche Scientifique</orgName><orgName type="acronym">CNRS</orgName><date type="start">1939-10-19</date><desc><address><country key="FR"></country></address><ref type="url">http://www.cnrs.fr/</ref></desc></org></tutelle></tutelles></hal:affiliation><country>France</country></affiliation></author><author><name sortKey="Derrey, Stephane" sort="Derrey, Stephane" uniqKey="Derrey S" first="Stéphane" last="Derrey">Stéphane Derrey</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-111551" status="VALID"><orgName>Service de neurochirurgie</orgName><desc><address><country key="FR"></country></address></desc><listRelation><relation active="#struct-300147" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-300147" type="direct"><org type="institution" xml:id="struct-300147" status="VALID"><orgName>CHU Rouen</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle></tutelles></hal:affiliation><country>France</country></affiliation></author><author><name sortKey="Dormont, Didier" sort="Dormont, Didier" uniqKey="Dormont D" first="Didier" last="Dormont">Didier Dormont</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-218549" status="OLD"><orgName>Equipe NEMESIS - Centre de Recherches de l'Institut du Cerveau et de la Moelle épinière</orgName><orgName type="acronym">NEMESIS-CRICM</orgName><desc><address><addrLine>47 boulevard de l'hôpital 75013 Paris</addrLine><country key="FR"></country></address></desc><listRelation><relation active="#struct-93591" type="direct"></relation><relation name="U975" active="#struct-300002" type="direct"></relation><relation name="UMR7225" active="#struct-441569" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-93591" type="direct"><org type="institution" xml:id="struct-93591" status="VALID"><orgName>Université Pierre et Marie Curie - Paris 6</orgName><orgName type="acronym">UPMC</orgName><desc><address><addrLine>4 place Jussieu - 75005 Paris</addrLine><country key="FR"></country></address><ref type="url">http://www.upmc.fr/</ref></desc></org></tutelle><tutelle name="U975" active="#struct-300002" type="direct"><org type="institution" xml:id="struct-300002" status="VALID"><orgName>INSERM</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle><tutelle name="UMR7225" active="#struct-441569" type="direct"><org type="institution" xml:id="struct-441569" status="VALID"><idno type="IdRef">02636817X</idno><idno type="ISNI">0000000122597504</idno><orgName>Centre National de la Recherche Scientifique</orgName><orgName type="acronym">CNRS</orgName><date type="start">1939-10-19</date><desc><address><country key="FR"></country></address><ref type="url">http://www.cnrs.fr/</ref></desc></org></tutelle></tutelles></hal:affiliation><country>France</country></affiliation></author><author><name sortKey="Cornu, Philippe" sort="Cornu, Philippe" uniqKey="Cornu P" first="Philippe" last="Cornu">Philippe Cornu</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-41019" status="VALID"><orgName>Service de neuro-chirurgie [Pitié-Salpétrière]</orgName><desc><address><addrLine>47-83, boulevard de l'Hôpital 75651 Paris Cedex 13</addrLine><country key="FR"></country></address></desc><listRelation><relation active="#struct-300068" type="direct"></relation><relation active="#struct-300887" type="direct"></relation><relation active="#struct-93591" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-300068" type="direct"><org type="institution" xml:id="struct-300068" status="VALID"><orgName>Assistance publique - Hôpitaux de Paris (AP-HP)</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle><tutelle active="#struct-300887" type="direct"><org type="institution" xml:id="struct-300887" status="INCOMING"><orgName>Hôpital Pitié-Salpêtrière</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle><tutelle active="#struct-93591" type="direct"><org type="institution" xml:id="struct-93591" status="VALID"><orgName>Université Pierre et Marie Curie - Paris 6</orgName><orgName type="acronym">UPMC</orgName><desc><address><addrLine>4 place Jussieu - 75005 Paris</addrLine><country key="FR"></country></address><ref type="url">http://www.upmc.fr/</ref></desc></org></tutelle></tutelles></hal:affiliation><country>France</country></affiliation></author><author><name sortKey="Yelnik, Jerome" sort="Yelnik, Jerome" uniqKey="Yelnik J" first="Jérôme" last="Yelnik">Jérôme Yelnik</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-2623" status="VALID"><orgName>CIC AP-HP (pitie-Salpetriere)/inserm</orgName><desc><address><addrLine>Gh Pitie-Salpetriere PARIS VI 47, Boulevard de L'Hopital 75651 PARIS CEDEX 13</addrLine><country key="FR"></country></address><ref type="url">http://cicsalpetriere.ap-hop-paris.fr</ref></desc><listRelation><relation active="#struct-93591" type="direct"></relation><relation name="CIC9503" active="#struct-300002" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-93591" type="direct"><org type="institution" xml:id="struct-93591" status="VALID"><orgName>Université Pierre et Marie Curie - Paris 6</orgName><orgName type="acronym">UPMC</orgName><desc><address><addrLine>4 place Jussieu - 75005 Paris</addrLine><country key="FR"></country></address><ref type="url">http://www.upmc.fr/</ref></desc></org></tutelle><tutelle name="CIC9503" active="#struct-300002" type="direct"><org type="institution" xml:id="struct-300002" status="VALID"><orgName>INSERM</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle></tutelles></hal:affiliation><country>France</country></affiliation></author><author><name sortKey="Karachi, Carine" sort="Karachi, Carine" uniqKey="Karachi C" first="Carine" last="Karachi">Carine Karachi</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-81470" status="OLD"><orgName>Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière [Paris]</orgName><orgName type="acronym">CRICM</orgName><desc><address><addrLine>GH Pitié-Salpêtrière 47, boulevard de l'Hôpital 75651 Paris cedex 13</addrLine><country key="FR"></country></address><ref type="url">http://www.cricm.upmc.fr/</ref></desc><listRelation><relation active="#struct-93591" type="direct"></relation><relation name="U975" active="#struct-300002" type="direct"></relation><relation name="UMR7225" active="#struct-441569" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-93591" type="direct"><org type="institution" xml:id="struct-93591" status="VALID"><orgName>Université Pierre et Marie Curie - Paris 6</orgName><orgName type="acronym">UPMC</orgName><desc><address><addrLine>4 place Jussieu - 75005 Paris</addrLine><country key="FR"></country></address><ref type="url">http://www.upmc.fr/</ref></desc></org></tutelle><tutelle name="U975" active="#struct-300002" type="direct"><org type="institution" xml:id="struct-300002" status="VALID"><orgName>INSERM</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle><tutelle name="UMR7225" active="#struct-441569" type="direct"><org type="institution" xml:id="struct-441569" status="VALID"><idno type="IdRef">02636817X</idno><idno type="ISNI">0000000122597504</idno><orgName>Centre National de la Recherche Scientifique</orgName><orgName type="acronym">CNRS</orgName><date type="start">1939-10-19</date><desc><address><country key="FR"></country></address><ref type="url">http://www.cnrs.fr/</ref></desc></org></tutelle></tutelles></hal:affiliation><country>France</country></affiliation></author></analytic><idno type="DOI">10.1002/mds.23448</idno><series><title level="j">Movement Disorders</title><idno type="ISSN">0885-3185</idno><imprint><date type="datePub">2011-02-01</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="mix" xml:lang="en"><term>deep brain stimulation</term><term>thalamus</term><term>tremor</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">High frequency stimulation of the ventral intermedius nucleus (Vim) of the thalamus is successfully used for the treatment of postural tremor. Target coordinates are most commonly calculated using a statistical method. Here, we compare a statistical and an individual targeting method, using an histology-based three-dimensional deformable brain atlas which allows localization of the Vim on individual patient's MR images by adaptation of the atlas onto the patient's brain. Twenty-nine consecutive patients had electrodes implanted in the Vim uni-or bilaterally for severe essential tremor. Thirty-five targets were determined by calculating the statistical target and then using the deformable atlas to compute the individual target. Pythagorean distance between these targets was calculated. Statistical and individual targets were compared by double blind evaluation of perioperative stimulation effects. For most cases (n = 24), the Pythagorean distance was higher than 1.5 mm. In 79% of these cases, the definitive electrode was implanted using the position of the individual target. For the remaining cases (n = 11, distance < 1.5 mm), the definitive electrode was implanted according to the statistical target location in 73% of the cases. As a whole, when individual target was used, it was located at least 2 mm more medial than the statistical one in 86% cases. These results suggest that Vim target determination based on a statistical method might be inaccurate. In particular, laterality might be overestimated, leading to nonoptimal clinical results. In clinical practice, this means that microelectrode exploration during Vim surgery should include at least one trajectory more medial than the statistical target.</div></front></TEI><hal api="V3"><titleStmt><title xml:lang="en">Thalamic stimulation for tremor: can target determination be improved?</title><author role="aut"><persName><forename type="first">Eric</forename><surname>Bardinet</surname></persName><email></email><idno type="halauthor">98501</idno><affiliation ref="#struct-218549"></affiliation><affiliation ref="#struct-106232"></affiliation></author><author role="aut"><persName><forename type="first">Hayat</forename><surname>Belaid</surname></persName><email></email><idno type="halauthor">527646</idno><affiliation ref="#struct-81470"></affiliation><affiliation ref="#struct-41019"></affiliation></author><author role="aut"><persName><forename type="first">David</forename><surname>Grabli</surname></persName><email></email><idno type="halauthor">362797</idno><affiliation ref="#struct-81470"></affiliation><affiliation ref="#struct-41019"></affiliation></author><author role="aut"><persName><forename type="first">Marie-Laure</forename><surname>Welter</surname></persName><email></email><idno type="halauthor">214475</idno><affiliation ref="#struct-81470"></affiliation><affiliation ref="#struct-2623"></affiliation><affiliation ref="#struct-5370"></affiliation></author><author role="aut"><persName><forename type="first">Sara Fernandez</forename><surname>Vidal</surname></persName><email></email><idno type="halauthor">822600</idno></author><author role="aut"><persName><forename type="first">Damien</forename><surname>Galanaud</surname></persName><email></email><idno type="halauthor">98502</idno><affiliation ref="#struct-218549"></affiliation><affiliation ref="#struct-41020"></affiliation></author><author role="aut"><persName><forename type="first">Stéphane</forename><surname>Derrey</surname></persName><email></email><idno type="halauthor">478968</idno><affiliation ref="#struct-111551"></affiliation></author><author role="aut"><persName><forename type="first">Didier</forename><surname>Dormont</surname></persName><email></email><idno type="halauthor">98507</idno><affiliation ref="#struct-218549"></affiliation><affiliation ref="#struct-41020"></affiliation></author><author role="aut"><persName><forename type="first">Philippe</forename><surname>Cornu</surname></persName><email></email><idno type="halauthor">385265</idno><affiliation ref="#struct-41019"></affiliation></author><author role="aut"><persName><forename type="first">Jérôme</forename><surname>Yelnik</surname></persName><email></email><idno type="halauthor">404202</idno><affiliation ref="#struct-2623"></affiliation><affiliation ref="#struct-81470"></affiliation></author><author role="aut"><persName><forename type="first">Carine</forename><surname>Karachi</surname></persName><email></email><idno type="halauthor">527644</idno><affiliation ref="#struct-81470"></affiliation><affiliation ref="#struct-41019"></affiliation><affiliation ref="#struct-2623"></affiliation></author><editor role="depositor"><persName><forename>Olivier</forename><surname>Colliot</surname></persName><email>olivier.colliot@upmc.fr</email></editor></titleStmt><editionStmt><edition n="v1" type="current"><date type="whenSubmitted">2013-02-28 18:46:45</date><date type="whenModified">2013-04-09 09:12:37</date><date type="whenReleased">2013-02-28 18:46:45</date><date type="whenProduced">2011-02-01</date></edition><respStmt><resp>contributor</resp><name key="180860"><persName><forename>Olivier</forename><surname>Colliot</surname></persName><email>olivier.colliot@upmc.fr</email></name></respStmt></editionStmt><publicationStmt><distributor>CCSD</distributor><idno type="halId">hal-00795734</idno><idno type="halUri">https://hal.inria.fr/hal-00795734</idno><idno type="halBibtex">bardinet:hal-00795734</idno><idno type="halRefHtml">Movement Disorders, Wiley, 2011, 26 (2), pp.307-12. <10.1002/mds.23448></idno><idno type="halRef">Movement Disorders, Wiley, 2011, 26 (2), pp.307-12. <10.1002/mds.23448></idno></publicationStmt><seriesStmt><idno type="stamp" n="CNRS">CNRS - Centre national de la recherche scientifique</idno><idno type="stamp" n="UPMC">Université Pierre et Marie Curie</idno><idno type="stamp" n="ICM" p="UPMC">Institut du Cerveau et de la Moëlle Epinière</idno></seriesStmt><notesStmt><note type="audience" n="2">International</note><note type="popular" n="0">No</note><note type="peer" n="1">Yes</note></notesStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Thalamic stimulation for tremor: can target determination be improved?</title><author role="aut"><persName><forename type="first">Eric</forename><surname>Bardinet</surname></persName><idno type="halAuthorId">98501</idno><affiliation ref="#struct-218549"></affiliation><affiliation ref="#struct-106232"></affiliation></author><author role="aut"><persName><forename type="first">Hayat</forename><surname>Belaid</surname></persName><idno type="halAuthorId">527646</idno><affiliation ref="#struct-81470"></affiliation><affiliation ref="#struct-41019"></affiliation></author><author role="aut"><persName><forename type="first">David</forename><surname>Grabli</surname></persName><idno type="halAuthorId">362797</idno><affiliation ref="#struct-81470"></affiliation><affiliation ref="#struct-41019"></affiliation></author><author role="aut"><persName><forename type="first">Marie-Laure</forename><surname>Welter</surname></persName><idno type="halAuthorId">214475</idno><affiliation ref="#struct-81470"></affiliation><affiliation ref="#struct-2623"></affiliation><affiliation ref="#struct-5370"></affiliation></author><author role="aut"><persName><forename type="first">Sara Fernandez</forename><surname>Vidal</surname></persName><idno type="halAuthorId">822600</idno></author><author role="aut"><persName><forename type="first">Damien</forename><surname>Galanaud</surname></persName><idno type="halAuthorId">98502</idno><affiliation ref="#struct-218549"></affiliation><affiliation ref="#struct-41020"></affiliation></author><author role="aut"><persName><forename type="first">Stéphane</forename><surname>Derrey</surname></persName><idno type="halAuthorId">478968</idno><affiliation ref="#struct-111551"></affiliation></author><author role="aut"><persName><forename type="first">Didier</forename><surname>Dormont</surname></persName><idno type="halAuthorId">98507</idno><affiliation ref="#struct-218549"></affiliation><affiliation ref="#struct-41020"></affiliation></author><author role="aut"><persName><forename type="first">Philippe</forename><surname>Cornu</surname></persName><idno type="halAuthorId">385265</idno><affiliation ref="#struct-41019"></affiliation></author><author role="aut"><persName><forename type="first">Jérôme</forename><surname>Yelnik</surname></persName><idno type="halAuthorId">404202</idno><affiliation ref="#struct-2623"></affiliation><affiliation ref="#struct-81470"></affiliation></author><author role="aut"><persName><forename type="first">Carine</forename><surname>Karachi</surname></persName><idno type="halAuthorId">527644</idno><affiliation ref="#struct-81470"></affiliation><affiliation ref="#struct-41019"></affiliation><affiliation ref="#struct-2623"></affiliation></author></analytic><monogr><idno type="halJournalId" status="VALID">17211</idno><idno type="issn">0885-3185</idno><idno type="eissn">1531-8257</idno><title level="j">Movement Disorders</title><imprint><publisher>Wiley</publisher><biblScope unit="volume">26</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="pp">307-12</biblScope><date type="datePub">2011-02-01</date></imprint></monogr><idno type="doi">10.1002/mds.23448</idno><idno type="pubmed">21412838</idno></biblStruct></sourceDesc><profileDesc><langUsage><language ident="en">English</language></langUsage><textClass><keywords scheme="author"><term xml:lang="en">tremor</term><term xml:lang="en">deep brain stimulation</term><term xml:lang="en">thalamus</term></keywords><classCode scheme="halDomain" n="info.info-im">Computer Science [cs]/Medical Imaging</classCode><classCode scheme="halTypology" n="ART">Journal articles</classCode></textClass><abstract xml:lang="en">High frequency stimulation of the ventral intermedius nucleus (Vim) of the thalamus is successfully used for the treatment of postural tremor. Target coordinates are most commonly calculated using a statistical method. Here, we compare a statistical and an individual targeting method, using an histology-based three-dimensional deformable brain atlas which allows localization of the Vim on individual patient's MR images by adaptation of the atlas onto the patient's brain. Twenty-nine consecutive patients had electrodes implanted in the Vim uni-or bilaterally for severe essential tremor. Thirty-five targets were determined by calculating the statistical target and then using the deformable atlas to compute the individual target. Pythagorean distance between these targets was calculated. Statistical and individual targets were compared by double blind evaluation of perioperative stimulation effects. For most cases (n = 24), the Pythagorean distance was higher than 1.5 mm. In 79% of these cases, the definitive electrode was implanted using the position of the individual target. For the remaining cases (n = 11, distance < 1.5 mm), the definitive electrode was implanted according to the statistical target location in 73% of the cases. As a whole, when individual target was used, it was located at least 2 mm more medial than the statistical one in 86% cases. These results suggest that Vim target determination based on a statistical method might be inaccurate. In particular, laterality might be overestimated, leading to nonoptimal clinical results. In clinical practice, this means that microelectrode exploration during Vim surgery should include at least one trajectory more medial than the statistical target.</abstract></profileDesc></hal></record>Pour manipuler ce document sous Unix (Dilib)
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