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The dentato-rubro-thalamic tract (DRT) has been suspected as a common tremor-reducing structure. Statistical evidence has not been obtained. We here report the results of an uncontrolled case series of patients with refractory tremor who underwent deep brain stimulation under tractographic assistance.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A total of 36 patients were enrolled (essential tremor (17), Parkinson\u2019s tremor (8), multiple sclerosis (7), dystonic head tremor (3), tardive dystonia (1)) and received 62 DBS electrodes (26 bilateral; 10 unilateral). Preoperatively, diffusion tensor magnetic resonance imaging sequences were acquired together with high-resolution anatomical T1W and T2W sequences. The DRT was individually tracked and used as a direct thalamic or subthalamic target. Intraoperative tremor reduction was graded on a 4-point scale (0\u2009=\u2009no tremor reduction to 3\u2009=\u2009full tremor control) and recorded together with the current amplitude, respectively. Stimulation point coordinates were recorded and compared to DRT. The relation of the current amplitude needed to reduce tremor was expressed as TiCR (tremor improvement per current ratio).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Stimulation points of 241 were available for analysis. A total of 68 trajectories were tested (62\u00a0dB leads, 1.1 trajectories tested per implanted lead). Tremor improvement was significantly decreasing (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) if the distance to both the border and the center of the DRT was increasing. On the initial trajectory, 56 leads (90.3%) were finally placed. Long-term outcomes were not part of this analysis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Discussion<\/jats:title>\n                <jats:p>Tremor of various origins was acutely alleviated at different points along the DRT fiber tract (above and below the MCP plane) despite different tremor diseases. DRT is potentially a common tremor-reducing structure. Individual targeting helps to reduce brain penetrating tracts. TiCR characterizes stimulation efficacy and might help to identify an optimal stimulation point.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00701-020-04248-2","type":"journal-article","created":{"date-parts":[[2020,1,29]],"date-time":"2020-01-29T23:01:32Z","timestamp":1580338892000},"page":"1053-1066","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":92,"title":["The dentato-rubro-thalamic tract as the potential common deep brain stimulation target for tremor of various origin: an observational case series"],"prefix":"10.1007","volume":"162","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1703-6283","authenticated-orcid":false,"given":"Volker Arnd","family":"Coenen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bastian","family":"Sajonz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Prokop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Reisert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Piroth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horst","family":"Urbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolin","family":"Jenkner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter Christoph","family":"Reinacher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,1,29]]},"reference":[{"key":"4248_CR1","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/j.nicl.2018.01.008","volume":"18","author":"H Akram","year":"2018","unstructured":"Akram H, Dayal V, Mahlknecht P et al (2018) Connectivity derived thalamic segmentation in deep brain stimulation for tremor. 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VAC serves as medical advisor for CorTec, Freiburg, Germany and Cortics, Munich, Germany. PCR has received travel\/accommodations\/meeting expenses from Boston Scientific (CA, USA) and BrainLab (Munich, Germany). Dr. Coenen has occasionally received travel support and honoraria for lecturing and consulting from Medtronic (USA, Europe) and Boston Scientific (USA). Dr. Coenen has ongoing IIT\u2019s with Medtronic (USA; Europe) and Boston Scientific (USA) unrelated to this work. Dr. Coenen has an unrelated collaboration with BrainLab (Germany). Dr. Reinacher has occasionally received travel support and honoraria for lecturing and consulting from BrainLab (Germany) and Boston Scientific (USA). All other authors do not have any conflicts of interest related to this work.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee (name of institute\/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statement of informed consent"}}]}}