{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T21:20:08Z","timestamp":1791408008535,"version":"4.3.3"},"reference-count":35,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2011,11]]},"abstract":"\nObject<\/jats:title>\nDue to the lack of internal anatomical detail with traditional MR imaging, preoperative stereotactic planning for the treatment of tremor usually relies on indirect targeting based on atlas-derived coordinates. The object of this study was to preliminarily investigate the role of probabilistic tractography\u2013based thalamic segmentation for deep brain stimulation (DBS) targeting for the treatment of tremor.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nSix patients undergoing bilateral implantation of DBS electrodes in the thalamus for the treatment of upper-extremity tremor were studied. All patients underwent stereotactic surgical implantation using traditional methods (based on indirect targeting methodologies and intraoperative macrostimulation findings) that were programmed for optimal efficacy, independent of tractography-based segmentations described in this report. Connectivity-based thalamic segmentations were derived by identifying with which of 7 cortical target regions each thalamic voxel had the highest probability of connectivity. The authors retrospectively analyzed the location of the optimal contact for treatment of tremor with connectivity-based thalamic segmentations. Findings from one institution (David Geffen School of Medicine at UCLA) were validated with results from 4 patients at another institution (University of Virginia Health System).<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nOf 12 electrodes implanted using traditional methodologies, all but one resulted in efficacious tremor control. Connectivity-based thalamic segmentation consistently revealed discrete thalamic regions having unique connectivity patterns with distinct cortical regions. Although the authors initially hypothesized that the most efficacious DBS contact for controlling tremor would colocalize with the thalamic region most highly connected with the primary motor cortex, they instead found it to highly colocalize with those thalamic voxels demonstrating a high probability of connectivity with premotor cortex (center-to-center distance: 0.36 \u00b1 0.55 mm). In contrast to the high degree of colocalization with optimal stimulation site, the precise localization of the premotor cortex\u2013defined thalamic region relative to the anterior and posterior commissures was highly variable. Having defined a connectivity-based target for thalamic stimulation in a cohort of patients at David Geffen School of Medicine at UCLA, the authors validated findings in 4 patients (5 electrodes) who underwent surgery at a different institution (University of Virginia Health System) by a different surgeon.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nThis report identifies and provides preliminary external validation of a novel means of targeting a patient-specific therapeutic thalamic target for the treatment of tremor based on individualized analysis of thalamic connectivity patterns. This novel thalamic targeting approach is based on identifying the thalamic region with the highest probability of connectivity with premotor and supplementary motor cortices. This approach may prove to be advantageous over traditional preoperative methods of indirect targeting, providing patient-specific targets that could improve the precision, efficacy, and efficiency of deep brain stimulation surgery. Prospective evaluation and development of methodologies to make these analyses more widely available to neurosurgeons are likely warranted.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2011.7.jns11250","type":"journal-article","created":{"date-parts":[[2011,8,19]],"date-time":"2011-08-19T13:59:20Z","timestamp":1313762360000},"page":"995-1004","source":"Crossref","is-referenced-by-count":121,"title":["Multi-institutional evaluation of deep brain stimulation targeting using probabilistic connectivity-based thalamic segmentation"],"prefix":"10.3171","volume":"115","author":[{"given":"Nader","family":"Pouratian","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhong","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ausaf A.","family":"Bari","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Behnke","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Jeff","family":"Elias","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio A. F.","family":"DeSalles","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns11250","series-title":"Neurosci Lett","first-page":"166","article-title":"A randomized comparison of thalamic stimulation and lesion on self-paced finger movement in essential tremor","volume":"462","author":"Anderson","year":"2009"},{"key":"b2-jns11250","series-title":"Acta Neurochir (Wien)","first-page":"2089","article-title":"A role of diffusion tensor imaging in movement disorder surgery","volume":"152","author":"Barkhoudarian","year":"2010"},{"key":"b3-jns11250","series-title":"Neuroimage","first-page":"144","article-title":"Probabilistic diffusion tractography with multiple fibre orientations: what can we gain?","volume":"34","author":"Behrens","year":"2007"},{"key":"b4-jns11250","series-title":"Nat 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