The evolution of ventral intermediate nucleus targeting in MRI-guided focused ultrasound thalamotomy for essential tremor: an international multi-center evaluation
BackgroundThe ventral intermediate nucleus (VIM) is the premiere target in magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy for tremor; however, there is no consensus on the optimal coordinates for ablation. This study aims to ascertain the various international VIM targeting approa...
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Frontiers Media S.A.
2024-03-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2024.1345873/full |
| _version_ | 1797244822055026688 |
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| author | Ayesha Jameel Ayesha Jameel Sena Akgun Nada Yousif Joely Smith Brynmor Jones Dipankar Nandi Peter Bain Wladyslaw Gedroyc |
| author_facet | Ayesha Jameel Ayesha Jameel Sena Akgun Nada Yousif Joely Smith Brynmor Jones Dipankar Nandi Peter Bain Wladyslaw Gedroyc |
| author_sort | Ayesha Jameel |
| collection | DOAJ |
| description | BackgroundThe ventral intermediate nucleus (VIM) is the premiere target in magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy for tremor; however, there is no consensus on the optimal coordinates for ablation. This study aims to ascertain the various international VIM targeting approaches (VIM-TA) and any evolution in practice.MethodsInternational MRgFUS centers were invited to share VIM-TAs in 2019 and 2021. Analyses of any modification in practice and of anatomical markers and/or tractography in use were carried out. Each VIM-TA was mapped in relation to the mid-commissural point onto a 3D thalamic nucleus model created from the Schaltenbrand–Wahren atlas.ResultsOf the 39 centers invited, 30 participated across the study period, providing VIM-TAs from 26 centers in 2019 and 23 in 2021. The results are reported as percentages of the number of participating centers in that year. In 2019 and 2021, respectively, 96.2% (n = 25) and 95.7% (n = 22) of centers based their targeting on anatomical landmarks rather than tractography. Increased adoption of tractography in clinical practice and/or for research was noted, changing from 34.6% to 78.3%. There was a statistically significant change in VIM-TAs in the superior-inferior plane across the study period; the percentage of VIM-TAs positioned 2 mm above the intercommissural line (ICL) increased from 16.0% in 2019 to 40.9% in 2021 (WRST, p < 0.05). This position is mapped at the center of VIM on the 3D thalamic model created based on the Schaltenbrand–Wahren atlas. In contrast, the VIM-TA medial-lateral and anterior-posterior positions remained stable. In 2022, 63.3% of participating centers provided the rationale for their VIM-TAs and key demographics. The centers were more likely to target 2 mm above the ICL if they had increased experience (more than 100 treatments) and/or if they were North American.ConclusionAcross the study period, FUS centers have evolved their VIM targeting superiorly to target the center of the VIM (2 mm above the ICL) and increased the adoption of tractography to aid VIM localization. This phenomenon is observed across autonomous international centers, suggesting that it is a more optimal site for FUS thalamotomy in tremors. |
| first_indexed | 2024-04-24T19:17:07Z |
| format | Article |
| id | doaj.art-16554cd074264ab9bbe87be8f97cc16b |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-24T19:17:07Z |
| publishDate | 2024-03-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Neurology |
| spelling | doaj.art-16554cd074264ab9bbe87be8f97cc16b2024-03-26T04:49:06ZengFrontiers Media S.A.Frontiers in Neurology1664-22952024-03-011510.3389/fneur.2024.13458731345873The evolution of ventral intermediate nucleus targeting in MRI-guided focused ultrasound thalamotomy for essential tremor: an international multi-center evaluationAyesha Jameel0Ayesha Jameel1Sena Akgun2Nada Yousif3Joely Smith4Brynmor Jones5Dipankar Nandi6Peter Bain7Wladyslaw Gedroyc8Imperial College London, London, United KingdomImperial College Healthcare NHS Trust, London, United KingdomSapienza University of Rome, Rome, ItalyUniversity of Hertfordshire, Hatfield, United KingdomImperial College London, London, United KingdomImperial College Healthcare NHS Trust, London, United KingdomImperial College Healthcare NHS Trust, London, United KingdomImperial College London, London, United KingdomImperial College Healthcare NHS Trust, London, United KingdomBackgroundThe ventral intermediate nucleus (VIM) is the premiere target in magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy for tremor; however, there is no consensus on the optimal coordinates for ablation. This study aims to ascertain the various international VIM targeting approaches (VIM-TA) and any evolution in practice.MethodsInternational MRgFUS centers were invited to share VIM-TAs in 2019 and 2021. Analyses of any modification in practice and of anatomical markers and/or tractography in use were carried out. Each VIM-TA was mapped in relation to the mid-commissural point onto a 3D thalamic nucleus model created from the Schaltenbrand–Wahren atlas.ResultsOf the 39 centers invited, 30 participated across the study period, providing VIM-TAs from 26 centers in 2019 and 23 in 2021. The results are reported as percentages of the number of participating centers in that year. In 2019 and 2021, respectively, 96.2% (n = 25) and 95.7% (n = 22) of centers based their targeting on anatomical landmarks rather than tractography. Increased adoption of tractography in clinical practice and/or for research was noted, changing from 34.6% to 78.3%. There was a statistically significant change in VIM-TAs in the superior-inferior plane across the study period; the percentage of VIM-TAs positioned 2 mm above the intercommissural line (ICL) increased from 16.0% in 2019 to 40.9% in 2021 (WRST, p < 0.05). This position is mapped at the center of VIM on the 3D thalamic model created based on the Schaltenbrand–Wahren atlas. In contrast, the VIM-TA medial-lateral and anterior-posterior positions remained stable. In 2022, 63.3% of participating centers provided the rationale for their VIM-TAs and key demographics. The centers were more likely to target 2 mm above the ICL if they had increased experience (more than 100 treatments) and/or if they were North American.ConclusionAcross the study period, FUS centers have evolved their VIM targeting superiorly to target the center of the VIM (2 mm above the ICL) and increased the adoption of tractography to aid VIM localization. This phenomenon is observed across autonomous international centers, suggesting that it is a more optimal site for FUS thalamotomy in tremors.https://www.frontiersin.org/articles/10.3389/fneur.2024.1345873/fullmagnetic resonance guided focused ultrasound (MRgFUS)essential tremor (ET)movement disorderstremorventral intermediate nucleus (VIM)thalamotomy |
| spellingShingle | Ayesha Jameel Ayesha Jameel Sena Akgun Nada Yousif Joely Smith Brynmor Jones Dipankar Nandi Peter Bain Wladyslaw Gedroyc The evolution of ventral intermediate nucleus targeting in MRI-guided focused ultrasound thalamotomy for essential tremor: an international multi-center evaluation Frontiers in Neurology magnetic resonance guided focused ultrasound (MRgFUS) essential tremor (ET) movement disorders tremor ventral intermediate nucleus (VIM) thalamotomy |
| title | The evolution of ventral intermediate nucleus targeting in MRI-guided focused ultrasound thalamotomy for essential tremor: an international multi-center evaluation |
| title_full | The evolution of ventral intermediate nucleus targeting in MRI-guided focused ultrasound thalamotomy for essential tremor: an international multi-center evaluation |
| title_fullStr | The evolution of ventral intermediate nucleus targeting in MRI-guided focused ultrasound thalamotomy for essential tremor: an international multi-center evaluation |
| title_full_unstemmed | The evolution of ventral intermediate nucleus targeting in MRI-guided focused ultrasound thalamotomy for essential tremor: an international multi-center evaluation |
| title_short | The evolution of ventral intermediate nucleus targeting in MRI-guided focused ultrasound thalamotomy for essential tremor: an international multi-center evaluation |
| title_sort | evolution of ventral intermediate nucleus targeting in mri guided focused ultrasound thalamotomy for essential tremor an international multi center evaluation |
| topic | magnetic resonance guided focused ultrasound (MRgFUS) essential tremor (ET) movement disorders tremor ventral intermediate nucleus (VIM) thalamotomy |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2024.1345873/full |
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