• Anthony Diaz, Iahn Cajigas, Joacir G Cordeiro, Anil Mahavadi, Samir Sur, Daniel Garbin Di Luca, Danielle S Shpiner, Corneliu C Luca, and Jonathan R Jagid.
• Department of Neurological Surgery, University of Miami, Miami, Florida, USA.
• World Neurosurg. 2020 Aug 1; 140: e225-e233.

BackgroundDeep brain stimulation of the ventral intermediate nucleus (VIM) or caudal zona incerta (cZI) is effective for refractory essential tremor (ET). To refine stereotactic planning for lead placement, we developed a unique individualized anatomy-based planning protocol that targets both the VIM and the cZI in patients with ET.Methods33 patients with ET underwent VIM-cZI lead implantation with targeting based on our protocol. Indirect targeting was adjusted based on anatomic landmarks as reference lines bisecting the red nuclei and ipsilateral subthalamus. Outcomes were evaluated through the follow-up of 31.1 ± 18.4 months. Active contact coordinates were obtained from reconstructed electrodes in the Montreal Neurological Institute space using the MATLAB Lead-DBS toolbox.ResultsMean tremor improvement was 79.7% ± 22.4% and remained stable throughout the follow-up period. Active contacts at last postoperative visit had mean Montreal Neurological Institute coordinates of 15.5 ± 1.6 mm lateral to the intercommissural line, 15.3 ± 1.8 mm posterior to the anterior commissure, and 1.4 ± 2.9 mm below the intercommissural plane. No hemorrhagic complications were observed in the analyzed group.ConclusionsIndividualized anatomy-based VIM-cZI targeting is feasible and safe and is associated with favorable tremor outcomes.Copyright © 2020 Elsevier Inc. All rights reserved.

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