Stereotactic and Functional Neurosurgery最新文献

{"title":"Stereotactic Spinothalamic Mesencephalic Tractotomy for the treatment of Cancer Pain in the Neuromodulation era: Advocacy for the renaissance of a forgotten surgery.","authors":"Jean Régis, Ghassen Souissi, Anne Balossier","doi":"10.1159/000547640","DOIUrl":"https://doi.org/10.1159/000547640","url":null,"abstract":"<p><strong>Background: </strong>The radiofrequency unilateral interruption of the spinothalamic tract at the level of the superior colliculi in the mesencephalon is one of the more ancient functional neurosurgery operation. Based on the literature review our aim is to consider the potential role of this old intervention in the modern neurosurgical armamentarium against cancer pain taking into account the evolution of the operative technique and the emergence of alternative approaches.</p><p><strong>Material and method: </strong>We reviewed the literature in order to analyse the anatomical targeting of the spinothalamic tract, the technical strategies, the efficacy on pain, the morbi-mortality the comparison of the safety efficacy ratio with other surgical technics depending on the indications. Among 19 published series only 4 are reporting only cancer pain patients. Two of these 4 series are reporting an anterior approach.</p><p><strong>Results: </strong>At the level of the superior colliculi the spinothalamic tract location is quite stable. With the anterior approach, a trajectory parallel to the quadrigeminal plate and a target at 7-8 mm from the midline the rate of permanent oculomotor palsy is very low. In patients operated under local anaesthesia with electrical stimulation of the target area painful paraesthesia due to injury of the medial lemniscus are very rare (min 0 max 6%). The rate of patient with analgesia of the painful area pain relive and stop and stop of pain-drug in these conditions is around 80% (min 75%-max 86%) in cancer patients. Early pain recurrences appearing within a month are due to insufficient coagulation. When morphine pump is not an option this intervention can transform the comfort of the last days of patients with unilateral drug-resistant pain of the upper part of the body.</p><p><strong>Conclusion: </strong>Although very ancient the Stereotactic Spinothalamic Mesencephalic Tractotomy (SSMT) by radiofrequency (RF) is turning out to offer a very good safety efficacy for lateralized cancer pain at the upper part of the body in drug-resistant patients with a modest life expectancy. We recommend the young generation of neurosurgeon involved in pain surgery to learn this remarkably effective intervention.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-20"},"PeriodicalIF":2.4,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotactic Focused Ultrasound Mesencephalotomy for the Treatment of Head and Neck Cancer Pain.","authors":"W Jeffrey Elias, Chang-Chia Liu, Divine Nwafor, Patrick H Finan, Mark Quigg, Shayan Moosa","doi":"10.1159/000547639","DOIUrl":"https://doi.org/10.1159/000547639","url":null,"abstract":"<p><strong>Introduction: </strong>Historically, stereotactic mesencephalotomy was developed as a 'supraspinal' cordotomy for cancer and neuropathic pain. Early experiences relieved pain, but the procedure was never widely adopted because of the associated morbidity with midbrain lesioning. Contemporary image-guided lesioning could make this a feasible procedure for cancer patients suffering with pain.</p><p><strong>Methods: </strong>A single-center, nonrandomized, early phase trial was designed to treat patients with severe, refractory pain from head and neck cancer with unilateral MRI-guided focused ultrasound mesencephalotomy. Safety was the primary outcome, but measures of efficacy were assessed with pain intensity and more functional components of pain.</p><p><strong>Results: </strong>A discrete midbrain lesion was created for the five patients. Two had profound pain relief, one was partial, and two others were very brief. One patient was transiently obtunded and other procedural morbidities were mild: numbness (3), oculomotor disturbance (1), and agitation (1). Electroencephalography, somatosensory evoked potentials, and quantitative sensory testing were obtained when possible.</p><p><strong>Conclusion: </strong>Stereotactic focused ultrasound mesencephalotomy is a modern, image-guided, lesioning technique that may be effective for cancer pain.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrode tract oedema in stereo electroencephalography (SEEG).","authors":"Ming-Sheng Lim, Rayyan AlBaram, Aoife Leonard, Donncha O'Brien, Peter Widdess-Walsh, Ronan Kilbride, Kieron Sweeney","doi":"10.1159/000547449","DOIUrl":"https://doi.org/10.1159/000547449","url":null,"abstract":"<p><p>Introduction - Stereo-electroencephalography (SEEG) is a safe and effective procedure for the identification of the epileptogenic zone to guide epilepsy surgery. Electrode tract oedema in SEEG is poorly understood. This study reports on its incidence and its clinical and biochemical correlations. Methods - The presence of oedema along the electrode tract on patients after removal of SEEG electrodes was recorded and described. The trend of serum inflammatory markers of patients with and without oedema were compared with non-linear regression using 2nd and 3rd order polynomial models and the extra sum-of-squares F test. Results - 79.2% of patients had radiographic oedema. Two radiographic distributions of oedema are described. No statistical differences were found between the trends of serum inflammatory markers of patients with and without oedema. 8.6% of patients had isolated fevers of non-infectious origin. 11.4% of patients had subclinical haematomas. No patients had infective or thromboembolic complications. Conclusions - Radiographic electrode tract oedema is common in SEEG and runs a benign clinical course in our series.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":1.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of Resistant Cancer Pain: Prevalence, Clinical Burden, and Treatment Gaps.","authors":"Aaron Lawson McLean, Julian Kahr, Jean Régis, Marcel A Kamp, Christian Senft","doi":"10.1159/000547446","DOIUrl":"https://doi.org/10.1159/000547446","url":null,"abstract":"<p><strong>Background: </strong>Resistant cancer pain (RCP) remains a challenge in oncology, affecting patients whose pain persists despite guideline-based treatment. While advancements in pharmacological and interventional strategies have improved cancer pain management, barriers such as opioid access restrictions, provider knowledge gaps, and underutilization of specialized pain interventions contribute to inadequate relief. Understanding the epidemiology, classification, and risk factors for RCP is essential for improving treatment.</p><p><strong>Summary: </strong>This review examines the prevalence, pathophysiology, and burden of RCP, highlighting its impact on quality of life and healthcare systems. Pain severity is commonly assessed using numerical rating scales, but comprehensive frameworks like the Edmonton Classification System for Cancer Pain (ECS-CP) provide better insight into complex pain syndromes. Breakthrough pain, neuropathic pain, and cancer-induced bone pain are frequently linked to treatment resistance. While opioids remain central to pharmacological management, many patients require multimodal approaches, including adjuvant analgesics, interventional procedures, and radiation therapy. Neurosurgical options such as cordotomy, intrathecal drug delivery, and myelotomy offer pain relief in select cases but are underutilized due to limited awareness and training.</p><p><strong>Key messages: </strong>RCP remains a major unmet medical need, affecting many cancer patients despite advances in pain management. Effective treatment requires a multimodal, individualized approach integrating pharmacological, interventional, and neurosurgical strategies. While neurosurgical interventions provide substantial relief in selected patients, their use is often limited by referral delays and lack of provider awareness. Overcoming systemic barriers, refining pain classification, and expanding access to specialized pain management are essential to improving RCP care.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-20"},"PeriodicalIF":1.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurosurgical Techniques for Chronic Pain in Adult Cancer Survivors.","authors":"Juan Manuel Altamirano, Syed I Khalid, Konstantin V Slavin","doi":"10.1159/000547391","DOIUrl":"https://doi.org/10.1159/000547391","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain is a prevalent and often undertreated issue for adult cancer survivors, lasting well beyond the completion of curative treatment or during prolonged maintenance therapy. Historically, pain management in this population has followed strategies similar to those used for active cancer pain-primarily systemic opioids-despite the long-term risks of functional decline, endocrine disruption, and misuse during periods of survivorship that may span decades.</p><p><strong>Summary: </strong>This review examines the evolving role of neuromodulatory and functional neurosurgical interventions for chronic pain in adult cancer survivors. It focuses on five core modalities: spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRGS), peripheral nerve stimulation (PNS), intrathecal drug delivery systems (IDDS), and cortical stimulation. These interventions are placed in context with three survivor groups: those cured of disease, those living with stable disease on chronic therapy, and survivors of hematopoietic cell transplantation. Emerging clinical evidence supports the use of SCS for treatment-related neuropathic and mixed pain syndromes, while DRGS and PNS show promise in addressing focal neuropathic conditions. IDDS offers a means to deliver targeted analgesia in patients suffering from diffuse or opioid-refractory pain, and cortical stimulation is currently being investigated for highly refractory cases. Each modality is examined in relation to common pain syndromes in survivorship, including chemotherapy-induced peripheral neuropathy, post-surgical neuropathy, radiation fibrosis, graft-versus-host disease-related pain, and musculoskeletal or myofascial pain. The review also explores unique survivorship considerations such as immunosuppression, device longevity, healing complications, and disparities in access and coverage.</p><p><strong>Key messages: </strong>Neuromodulation and functional neurosurgical techniques represent an emerging approach for managing chronic pain in adult cancer survivors, providing alternatives to systemic pharmacotherapy that may enhance quality of life and functional independence. The clinical application of these interventions should be guided by pain phenotype, underlying pathophysiology, and long-term survivorship needs. Their integration into cancer survivorship care necessitates careful consideration of patient selection, device management over time, procedural risks in immunocompromised individuals, and the ethical imperative for informed, shared decision-making.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":1.9,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term patient reported outcomes of multi-contact independent current control spinal cord stimulation in patients with chronic low back and extremity pain: an exploratory prospective cohort study.","authors":"Leonard H Verhey, Andres Restrepo Orozco, Daniel Mankoff, Kost Elisevich, Sanjay Patra","doi":"10.1159/000546430","DOIUrl":"https://doi.org/10.1159/000546430","url":null,"abstract":"<p><strong>Introduction: </strong>The effect of multi-contact independent current control (MICC) spinal cord stimulation (SCS) on patient-reported outcomes in those who have lost therapeutic efficacy of a conventional SCS is not well described. We prospectively evaluated self-reported pain, disability, and quality of life in patients with persistent spinal pain syndrome type 2 (PSPS-2) who were converted from a conventional to MICC SCS.</p><p><strong>Methods: </strong>Patients with PSPS-2 who had lost therapeutic efficacy with a constant current control (CCC) or voltage control (VC) system were enrolled, and had a MICC generator implanted. All participants were followed prospectively with standardized assessments of pain (Visual Analog Scale, VAS), condition-specific function (Oswestry Disability Index, ODI), and quality of life (Short-Form-36) at three- and six-months post-implantation.</p><p><strong>Results: </strong>Fifteen participants were eligible for inclusion; three were lost to follow-up. Mean VAS score was significantly decreased at 3 months (5.3±2.5, p=0.009) and 6 months (5.1±2.8, p=0.005) relative to pre-implantation (VAS 8.3±0.8). At 30 months, mean VAS remained significantly decreased (5.8±1.6, p<0.001). Mean disability score was significantly decreased at six months (ODI 40.5±14.7, p=0.029) compared to the mean preoperative score (53.6±14.7). At 6 months, the minimum clinically important difference (MCID) for VAS was met by 90% of patients and for ODI by 100%.</p><p><strong>Conclusion: </strong>This exploratory study suggests that MICC programming may represent a reasonable short-term salvage option for patients with PSPS-2 who have lost therapeutic efficacy with a CCC or VC SCS system. A larger study is required to evaluate superiority in terms of long-term pain control of MICC versus conventional SCS.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-17"},"PeriodicalIF":1.9,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gamma Knife Radiosurgery for Tumor-Related Trigeminal Neuralgia: A Single-center Retrospective Study.","authors":"Andrea Franzini, Piero Picozzi, Stefano Tomatis, Beatrice Claudia Bono, Zefferino Rossini, Maria Pia Tropeano, Ali Baram, Elena Clerici, Marta Scorsetti, Pierina Navarria, Federico Pessina","doi":"10.1159/000547063","DOIUrl":"https://doi.org/10.1159/000547063","url":null,"abstract":"<p><strong>Background: </strong>Tumor-related trigeminal neuralgia (TN) is a challenging condition to manage that can be treated with Gamma Knife Radiosurgery (GKRS) by targeting the tumor, the trigeminal nerve, or both. However, data regarding the efficacy of this treatment are somewhat limited.</p><p><strong>Objectives: </strong>To report outcomes of GKRS for tumor-related TN from a cohort study.</p><p><strong>Methods: </strong>Retrospective review of our GKRS database identified 41 patients with benign tumor-related TN treated with GKRS between 2014 and 2024. Background medical history, treatment outcomes and complications, and dosimetric data were obtained by chart review.</p><p><strong>Results: </strong>The tumor, the trigeminal nerve alone, or a combination of both were targeted in 28, 7, and 6 patients, for a total of 47 GKRS procedures. Eight(24%) patients had pain control before GKRS targeting the tumor. Thirty(88%) and 11(85%) patients had pain control after GKRS targeting the tumor and the trigeminal nerve, respectively. After a median follow-up of 63 months, pain recurred in 8(24%) and 3(23%) patients in the two groups. After tumor- and nerve-targeted GKRS, estimated rates of pain control at 1, 4, 7 and 10 years were 82%, 69%, 56%, and 56%, and 77%, 67%, 50%, and 50%, respectively. When GKRS targeting the tumor and the trigeminal nerve were considered as part of the same treatment, estimated rates of pain control at 1, 4, 7 and 10 years were 83%, 75%, 71%, and 71%. After tumor- and nerve-targeted GKRS, respectively, 5(15%) and 3(23%) patients developed persistent non-bothersome facial hypesthesia.</p><p><strong>Conclusions: </strong>GKRS targeting the tumor is an effective, well-tolerated treatment for patients with tumor-related TN. More durable relief is achieved in some patients with second-stage GKRS targeting the trigeminal nerve, but with additional facial sensory disturbances.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-20"},"PeriodicalIF":1.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there a role for focused ultrasound in the treatment of refractory epilepsy?","authors":"Alexander Agopyan-Miu, Grace B Simmons, Gordon H Baltuch","doi":"10.1159/000547265","DOIUrl":"https://doi.org/10.1159/000547265","url":null,"abstract":"<p><strong>Background: </strong>Although patients with drug-resistant epilepsy (DRE) have a <5% chance of seizure freedom with continued polypharmacy, surgical interventions remain underutilized. One potential driver of this trend is patient perceived fear of open surgery. Focused ultrasound is an incisionless, minimally invasive technique that has been used to treat epilepsy and has the potential to have a larger footprint within the epilepsy surgeon's armamentarium.</p><p><strong>Summary: </strong>A brief overview of the underutilization of epilepsy surgery, the epilepsy treatment landscape, and current and emerging applications of focused ultrasound for DRE will be discussed. This article includes a brief comparison of focused ultrasound with other alternatives to open epilepsy surgery and a summary and appraisal of the existing literature.</p><p><strong>Key messages: </strong>Focused ultrasound serves as a versatile, minimally invasive option for patients with contraindications to or concerns with open surgery or radiation exposure. Preliminary studies indicate disease-modifying benefit of high-intensity focused ultrasound (HIFU) ablation and potential neuromodulatory benefit and increased blood-brain barrier permeability of low-intensity focused ultrasound (LIFU). Higher level evidence is needed to elucidate the efficacy of LIFU and HIFU for the treatment of epilepsy. However, focused ultrasound is an emerging treatment modality that has the potential to transcend the traditional ablation paradigm and alter the cellular composition of epileptic networks for therapeutic effect.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-28"},"PeriodicalIF":1.9,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty Indices in Patients Undergoing Functional Neurosurgical Procedures: A Systematic Review.","authors":"Carmelo Venero, Joanna M Roy, Nirbha Ghurye, Akshay Warrier, Muhammad Usman Khalid, Niels Pacheco-Barrios, Farhan A Mirza, Christian A Bowers","doi":"10.1159/000547128","DOIUrl":"https://doi.org/10.1159/000547128","url":null,"abstract":"<p><strong>Introduction: </strong>Functional neurosurgery covers a wide array of neurological disorders with an equally vast array of treatment modalities, including neuromodulation, decompressive, &amp; ablative therapies for disparate pathologies such as pain, neuromodulation, disconnection, and refractory epilepsy. One of the most common functional treatments is deep brain stimulation for movement disorders and select psychiatric diseases. Functional neurosurgery treats patients with reduced quality of life from pathological neuronal pathways. Optimal patient selection by preoperatively identifying high risk patients is critical for avoiding as many operative complications as possible, in addition to managing complications better once they occur. Frailty indices have demonstrated superior discrimination in predicting adverse postoperative outcomes across the spectrum of neurosurgical subspecialties when compared to increasing patient age. This systematic review describes multiple different frailty indices utilized by patients undergoing functional neurosurgery procedures.</p><p><strong>Methods: </strong>A systematic review of literature was performed using PubMed. The Newcastle Ottawa Scale (NOS) was used to assess for risk of bias and studies with NOS > 6 were considered high quality. An initial search identified 541 articles through our search strategy and, after screening and review, five met criteria for inclusion The 5-factor modified frailty index (mFI-5) and Risk Analysis Index (RAI) were most frequently utilized (n = 5). One study utilized single-hospital databases in contrast to the nationwide databases utilized by the other four studies.</p><p><strong>Results: </strong>RAI was found to have superior predictive ability as frailty metric when compared to the mFI-5. All five studies were considered high-quality based on the NOS. Frailty indices have demonstrated the ability to predict adverse outcomes in patients undergoing procedures from across the spectrum of neurosurgical subspecialties.</p><p><strong>Conclusion: </strong>Our review identified articles that utilized frailty indices in predicting outcomes among patients undergoing functional neurosurgery procedures.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-16"},"PeriodicalIF":1.9,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144554917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structural connectivity of the basal ganglia from patient-individual tractography is key for understanding the effects of deep brain stimulation in Parkinson's Disease.","authors":"Ricardo Loução, Martin Kocher, Gregor Alexander Brandt, Jan Niklas Petry-Schmelzer, Michael Barbe, Haidar Dafsari, Josef Mana, Robert Jech, Jochen Wirths, Veerle Visser-Vandewalle, Pablo Andrade, Halim Baqapuri, Michael Luehrs, David E J Linden, Brendan Santyr, Andres Lozano, Alessandro Bongioanni, Bechir Jarraya, Tolga Cukur","doi":"10.1159/000546716","DOIUrl":"https://doi.org/10.1159/000546716","url":null,"abstract":"<p><strong>Background: </strong>In Parkinson's disease (PD) patients, modulation of the fibre tracts of the cortico-basal ganglia-thalamo-cortical loop is the presumed mechanism of action of deep brain stimulation (DBS) of the subthalamic nucleus (STN). Therefore, we explored patient-individual cortical structural connectivity of the volume of tissue activated (VTA), as well as DBS-induced modulation of fibre tracts connecting the STN with cortical and subcortical nodes, and their correlation with therapeutic effects.</p><p><strong>Patients and methods: </strong>A retrospective cohort of n = 69 PD patients treated with bilateral DBS of the STN was analysed. Clinical response was assessed from the DBS-induced change in the UPDRS-III motor scores (total and symptom-specific sub-scores) under regular medication after a median follow-up of 9.0 (range 2.6 - 20.2) months. Tractography based on patient-individual diffusion-weighted MRI was employed in two ways. Whole brain tractography was used to identify the cortical connections of fibres passing the VTAs, and reconstruction of specific white matter pathways of the motor loop connecting the STN with the basal ganglia and cortex were used to identify the proportion of fibres within these pathways which was modulated by STN-DBS. This proportion of pathway modulation was used in a correlative analysis with clinical outcomes.</p><p><strong>Results: </strong>Fibres traversing the VTAs were primarily connected to the supplementary motor area (SMA) and to a lesser degree to the premotor cortex. Within the pathways connecting the STN with the cortical and subcortical nodes, on average 30-40% (range 10-80%) of the fibres were modulated by STN-DBS. This proportion correlated significantly with the percentage change in UPDRS motor score for fibres connecting the STN with the SMA (ρ=0.28), pre-SMA (ρ=0.26), ventral and dorsal pre-motor cortices (ρ=0.26 and ρ=0.29, respectively), and the globus pallidus externus (GPe, ρ=0.26) and internus (GPi, ρ=0.29). Also, good clinical responses for both tremor and rigidity were associated with a significantly (p < 0.05) higher proportion of modulated fibres for the same cortico- and sub-cortico-STN connections.</p><p><strong>Conclusions: </strong>Patient-individual tractography reveals that, in PD, most of the cortical fibres traversing the VTA are connected to the SMA. In addition, clinical efficacy is related to the proportion of DBS-affected fibres connecting the STN with nodes of both the hyperdirect (cortex-STN) and the indirect pathways (STN-basal ganglia). As such, patient-specific tractography, in particular in the basal ganglia, could be used in a clinical context as a tool to guide therapy.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-29"},"PeriodicalIF":1.9,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}