The Pallidothalamic Tract in Functional Neurosurgery: A Systematic Review.

IF 2.1 4区医学 Q3 NEUROIMAGING

Stereotactic and Functional Neurosurgery Pub Date : 2026-10-20 DOI:10.1159/sfn/aeuag006

Mohammad Walid Al-Smadi, Yousif Qais Al-Khafaji, Siran Aslan, Davide Giampiccolo, San San Xu, Harith Akram, Patricia Limousin, Tom Foltynie, Ludvic Zrinzo, Marie T Krueger

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引用次数: 0

Abstract

Introduction: The pallidothalamic tract (PTT), formed by convergence of the ansa lenticularis and fasciculus lenticularis at Forel's field H1, is a major basal ganglia efferent pathway and an emerging functional neurosurgical target. No systematic review has previously synthesised outcomes across PTT-targeted interventions.

Methods: This PRISMA 2020-compliant systematic review was registered on PROSPERO (CRD420251248260). PubMed, OVID, and Web of Science were searched for studies reporting functional neurosurgical outcomes targeting the PTT or Forel's fields. Prospective and retrospective studies, case series, and case reports were eligible. Methodological quality was assessed using design-appropriate risk-of-bias tools.

Results: Forty studies encompassing 483 patients (1966-2025) were included across five modalities: MR-guided focused ultrasound (n = 143), radiofrequency ablation (n = 167), deep brain stimulation (n = 40), cryogenic lesioning (n = 82), and oil-wax injection (n = 52). Mean follow-up was 21 months. In Parkinson disease (PD; 11 studies; n = 135), mean Unified Parkinson's Disease Rating Scale-III improvement was 39%, with reductions in dyskinesia (Unified Dyskinesia Ratings Scale 90%) and tremor (75%). In dystonia (12 studies; n = 87), Burke Fahn Marsden Dystonia Rating Scale and TWSTRS improved by 57% and 47%, respectively. Dual-target strategies, particularly PTT-VIM combinations, showed additive effects, including greater tremor reduction (77%) and improved rigidity. In drug-resistant epilepsy (6 studies; n = 157), seizure reduction occurred in 71% and seizure freedom in 33%.

Conclusion: PTT-targeted interventions yield meaningful motor improvements in PD and dystonia, with preliminary evidence supporting additive dual-target benefits. Seizure-reducing effects in refractory epilepsy have been reported. Evidence remains limited by small uncontrolled studies, heterogeneous outcomes, and inconsistent adverse-event reporting. Prospective trials will elucidate the efficacy, safety, and clinical role of the PTT in neurosurgery.

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功能性神经外科中的丘脑皮层束：系统综述。

背景：胼胝体束（pallidothalamic tract， PTT）是基底神经节的一个主要传出通路，也是一个新兴的功能性神经外科靶点，由透镜束和透镜束在Forel's field H1汇合而成。以前没有系统评价综合了针对ptt的干预措施的结果。方法：该系统评价符合PRISMA 2020标准，注册号为PROSPERO （CRD420251248260）。PubMed， OVID和Web of Science检索了针对PTT或Forel领域的功能性神经外科结果的研究报告。前瞻性和回顾性研究、病例系列和病例报告均符合条件。采用适合设计的偏倚风险工具评估方法学质量。结果：40项研究包括483例患者（1966-2025），包括5种模式：磁共振引导聚焦超声（n=143）、射频消融（n=167）、深部脑刺激（n=40）、低温病变（n=82）和油蜡注射（n=52）。平均随访21个月。在帕金森病（11项研究，n=135）中，平均UPDRS-III改善为39%，运动障碍（UDysRS为90%）和震颤（75%）减少。在肌张力障碍（12项研究，n=87）中，BFMDRS和TWSTRS分别改善了57%和47%。双靶点策略，特别是PTT-VIM组合，显示出累加效应，包括更大的震颤减少（77%）和改善刚性。在耐药癫痫中（6项研究；n=157）， 71%的患者癫痫发作减少，33%的患者癫痫发作自由。结论：ptt靶向干预对帕金森病和肌张力障碍的运动改善有意义，初步证据支持附加的双靶点益处。减少难治性癫痫发作的效果已有报道。证据仍然受到小型非对照研究、异质性结果和不一致的不良事件报告的限制。前瞻性试验将阐明PTT在神经外科中的有效性、安全性和临床作用。

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

Stereotactic and Functional Neurosurgery 医学-神经成像

CiteScore

3.80

自引率

0.00%

发文量

审稿时长

3 months

期刊介绍： ''Stereotactic and Functional Neurosurgery'' provides a single source for the reader to keep abreast of developments in the most rapidly advancing subspecialty within neurosurgery. Technological advances in computer-assisted surgery, robotics, imaging and neurophysiology are being applied to clinical problems with ever-increasing rapidity in stereotaxis more than any other field, providing opportunities for new approaches to surgical and radiotherapeutic management of diseases of the brain, spinal cord, and spine. Issues feature advances in the use of deep-brain stimulation, imaging-guided techniques in stereotactic biopsy and craniotomy, stereotactic radiosurgery, and stereotactically implanted and guided radiotherapeutics and biologicals in the treatment of functional and movement disorders, brain tumors, and other diseases of the brain. Background information from basic science laboratories related to such clinical advances provides the reader with an overall perspective of this field. Proceedings and abstracts from many of the key international meetings furnish an overview of this specialty available nowhere else. ''Stereotactic and Functional Neurosurgery'' meets the information needs of both investigators and clinicians in this rapidly advancing field.