Optimal focused ultrasound lesion location in essential tremor

IF 11.7 1区综合性期刊 Q1 MULTIDISCIPLINARY SCIENCES

Science Advances Pub Date : 2025-05-14 DOI:10.1126/sciadv.adp0532

Melissa M. J. Chua, Alfredo Morales Pinzon, Clemens Neudorfer, Patrick R. Ng, Sarah E. Blitz, Garance M. Meyer, Konstantin Butenko, Till A. Dembek, Alexandre Boutet, Andrew Z. Yang, Michael Schwartz, Jürgen Germann, Nir Lipsman, Andres Lozano, Fardad Behzadi, Nathan J. McDannold, John D. Rolston, Charles R. G. Guttmann, Michael D. Fox, G. Rees Cosgrove, Andreas Horn

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Abstract

Magnetic resonance–guided focused ultrasound (MRgFUS) thalamotomy is an effective treatment for medically refractory essential tremor. We investigate ablation sites and potential tracts associated with optimal tremor control and side effects based on the analysis of 351 cases from three international hospitals. Lesions were segmented on day 1 thin-cut T2 axial images, mapped to standard Montreal Neurological Institute space, and used to derive probabilistic maps and tracts associated with tremor improvement and side effects. Lesioning of a specific subregion within the ventral intermediate nucleus and the cerebellothalamic tract was associated with optimal tremor improvements. Some lesion locations and tracts were associated with differential side effects. Overlaps with the optimal tremor improvement sites accounted for variance in clinical improvements in out-of-sample cases. Efficacy of this location was further confirmed by test-retest cases that underwent two MRgFUS procedures. We identify and validate a target area for optimal tremor control and sites of avoidance associated with side effects.

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特发性震颤的最佳超声病灶定位

磁共振引导聚焦超声（MRgFUS）丘脑切开术是治疗难治性特发性震颤的有效方法。我们通过对来自三家国际医院的351例病例的分析，研究了与最佳震颤控制相关的消融部位和潜在束。在第1天的薄切T2轴向图像上对病变进行分割，映射到标准的蒙特利尔神经学研究所空间，并用于导出与震颤改善和副作用相关的概率图和束。腹侧中间核和小脑丘脑束内的特定亚区病变与最佳震颤改善有关。一些病变部位和束与不同的副作用有关。与最佳震颤改善部位的重叠解释了样本外病例临床改善的差异。经过两次MRgFUS手术的复测病例进一步证实了该位置的有效性。我们确定并验证了最佳震颤控制的目标区域和与副作用相关的避免地点。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Science Advances 综合性期刊-综合性期刊

CiteScore

21.40

自引率

1.50%

发文量

1937

审稿时长

29 weeks

期刊介绍： Science Advances, an open-access journal by AAAS, publishes impactful research in diverse scientific areas. It aims for fair, fast, and expert peer review, providing freely accessible research to readers. Led by distinguished scientists, the journal supports AAAS's mission by extending Science magazine's capacity to identify and promote significant advances. Evolving digital publishing technologies play a crucial role in advancing AAAS's global mission for science communication and benefitting humankind.