• World Neurosurg · Jul 2020

    Variability Between Direct and Indirect Targeting of the Anterior Nucleus of the Thalamus.

    • Sanjeet S Grewal, Erik H Middlebrooks, Lela Okromelidze, Grant P Gosden, William O Tatum, Brian N Lundstrom, Gregory A Worrell, Robert E Wharen, and Jamie J Van Gompel.
    • Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA.
    • World Neurosurg. 2020 Jul 1; 139: e70-e77.

    BackgroundPreoperative thalamic targeting methods have historically relied on indirect targeting techniques that do not fully account for variances in anatomy or for thalamic atrophy in epilepsy. We aimed to address variability noted between traditional indirect targeting and direct targeting methods for the anterior nucleus of the thalamus (ANT).MethodsFifteen consecutive patients undergoing ANT deep brain stimulator placement were evaluated (30 thalamic nuclei). Direct ANT targeting was performed using a fast gray matter acquisition T1 inversion recovery sequence and compared with standard stereotactic coordinates. Thalamic volumes were calculated for each patient, and degree of thalamic volume loss was assessed compared with matched control subjects. Vertex analysis was performed to assess shape changes in the thalamus compared with age- and sex-matched subjects.ResultsThere was significant variation between direct and indirect targets in the y-axis and z-axis on both sides. On the left, the direct target was located at y = 2 ± 1.3 mm and z = 9.3 ± 1.8 mm (both P = 0.02). On the right, the direct target was located at y = 2.9 ± 1.8 mm and z = 9.2 ± 2 mm (both P ≤ 0.0003). There was no significant difference in the x-coordinate on either side (P > 0.5). Additionally, there was a correlation between thalamic volume and difference between direct and indirect targets in the y-axis and the z-axis.ConclusionsWe showed a significant difference in direct and indirect targeting in the y-axis and z-axis when targeting the ANT for deep brain stimulation for epilepsy. This difference is correlated to thalamic volume, with a larger difference noted in patients with thalamic atrophy.Copyright © 2020 Elsevier Inc. All rights reserved.

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