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64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

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Deep brain stimulation: Improvement of targeting in patients with essential tremor by identification of the dentato-rubro-thalamic tract with diffusion tensor imaging

Meeting Abstract

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  • Juergen Schlaier - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • Andreas Herbst - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • Julius Hoehne - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • Alexander Brawanski - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • Max Lange - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMI.04.04

doi: 10.3205/13dgnc304, urn:nbn:de:0183-13dgnc3042

Published: May 21, 2013

© 2013 Schlaier et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The aim of our study was to evaluate the influence of the stimulation site relative to the dentato-rubro-thalamic tract (DRTT) on the alleviation of tremor in deep brain stimulation.

Method: Ten DRTTs in five patients were investigated using preoperative diffusion tensor imaging (DTI). Regions of interest for fiber tracking were located in the cerebellar dentate nucleus, the superior cerebellar peduncle and the contralateral red nucleus. The position and distance of all intraoperative stimulation sites to the DRTT were measured and correlated to the amount of tremor reduction.

Results: 9 of 10 DRTTs could be identified using DTI based fiber tracking. The closer the stimulation site was located to the DRTT in the superior/inferior direction the better the tremor could be reduced (p <0.05). Better tremor reduction was achieved in locations in or posterior and lateral to the DRTT than in medial and anterior positions (p=0.001). Stimulation sites inferior to and in the DRTT achieved better results than locations superior to the DRTT (p <0.05).

Conclusions: In deep brain stimulation for patients with essential tremor the visualization of the dentato-rubro-thalamic tract might help to improve targeting and clinical results significantly.