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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Multicentre probabilistic mapping reveals optimal stimulation site in essential tremor

Multizentrische Studie zur Tiefen Hirnstimulation bei essentiellem Tremor identifiziert optimalen Stimulationsort

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  • presenting/speaker Andreas Nowacki - Inselspital, Universitätsspital Bern, Universitätsklinik für Neurochirurgie, Bern, Schweiz
  • Sabry Barlatey - Inselspital, Universitätsspital Bern, Universitätsklinik für Neurochirurgie, Bern, Schweiz
  • Bassam Al-Fatly - Charité – Universitätsmedizin Berlin, Berlin, Deutschland
  • Till A. Dembek - Universitätsklinikum Köln, Köln, Deutschland
  • Maarten Bot - Academic Medical Center, Amsterdam, Niederlande
  • Dorothee Kübler - Charité – Universitätsmedizin Berlin, Berlin, Deutschland
  • Ines Debove - Inselspital, Universitätsspital Bern, Bern, Schweiz
  • Lenard Lachenmayer - Inselspital, Universitätsspital Bern, Bern, Schweiz
  • Andreas Horn - Charité – Universitätsmedizin Berlin, Berlin, Deutschland
  • Veerle Visser-Vandewalle - Universitätsklinikum Köln, Köln, Deutschland
  • Michael T. Barbe - Universitätsklinikum Köln, Köln, Deutschland
  • Tipu Aziz - Nuffield Department of Clinical Neuroscience, Nuffield Department of Surgical Sciences, Oxford, Vereinigtes Königreich
  • Andrea Kühn - Charité – Universitätsmedizin Berlin, Berlin, Deutschland
  • Thuy-Anh Khoa Nguyen - Inselspital, Universitätsspital Bern, Bern, Schweiz
  • Claudio Pollo - Inselspital, Universitätsspital Bern, Universitätsklinik für Neurochirurgie, Bern, Schweiz

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV109

doi: 10.3205/22dgnc111, urn:nbn:de:0183-22dgnc1119

Published: May 25, 2022

© 2022 Nowacki et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: The objective of this study was to obtain individual clinical and neuroimaging data of patients who underwent Deep Brain Stimulation for essential tremor from five different European centers in order to identify predictors of outcome and to identify an optimal stimulation site.

Methods: This is a retrospective exploratory analysis. We collected baseline covariates, pre- and postoperative clinical tremor scores (12-month) as well as individual imaging data from 119 patients to obtain individual electrode positions and stimulation volumes. Individual imaging and clinical data was used to calculate a probabilistic stimulation map in normalized MNI space using voxel-wise statistical analysis. We used out-of-sample cross-validation techniques to estimate predictors of tremor reduction.

Results: Preoperative tremor severity was the only baseline parameter that showed a weak but significant correlation with postoperative DBS outcome. Probabilistic mapping of stimulation effects yielded statistically significant cluster of voxels that were associated with a clinically relevant greater than 47 % tremor improvement. This area of optimal stimulation extended from the posterior subthalamic area to the ventralis intermedius nucleus and coincided with the area of highest likelihood to contain the normative structural-connectivity-based cerebello-thalamic tract (CTT). The anatomical location of stimulation was the overall best predictor of outcome and could be used to correctly classify a greater than 50% tremor improvement with a sensitivity of 89% and a specificity of 57%.

Conclusion: Our multicentre ET probabilistic stimulation map identified an area of optimal stimulation along the course of the CTT. This target will be made openly available and may be used to guide surgical planning and for computer-assisted programming of deep brain stimulation in the future.