{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T16:34:29Z","timestamp":1781627669770,"version":"3.54.5"},"reference-count":45,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>The tremor circuitry has commonly been hypothesized to be driven by one or multiple pacemakers within the cerebello-thalamo-cortical pathway, including the cerebellum, contralateral motor thalamus, and primary motor cortex. However, previous studies, using multiple methodologies, have advocated that tremor could be influenced by changes within the right extrastriate cortex, at both the structural and functional level. The purpose of this work was to evaluate the role of the extrastriate cortex in tremor generation and further arrest after left unilateral stereotactic radiosurgery thalamotomy (SRS-T).<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors considered 12 healthy controls (HCs, group 1); 15 patients with essential tremor (ET, right-sided, drug-resistant; group 2) before left unilateral SRS-T; and the same 15 patients (group 3) 1 year after the intervention, to account for delayed effects. Blood oxygenation level\u2013dependent functional MRI during resting state was used to characterize the dynamic interactions of the right extrastriate cortex, comparing HC subjects against patients with ET before and 1 year after SRS-T. In particular, the authors applied coactivation pattern analysis to extract recurring whole-brain spatial patterns of brain activity over time.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The authors found 3 different sets of coactivating regions within the right extrastriate cortex in HCs and patients with pretherapeutic ET, reminiscent of the \u201ccerebello-visuo-motor,\u201d \u201cthalamo-visuo-motor\u201d (including the targeted thalamus), and \u201cbasal ganglia and extrastriate\u201d networks. The occurrence of the first pattern was decreased in pretherapeutic ET compared to HCs, whereas the other two patterns showed increased occurrences. This suggests a misbalance between the more prominent cerebellar circuitry and the thalamo-visuo-motor and basal ganglia networks. Multiple regression analysis showed that pretherapeutic standard tremor scores negatively correlated with the increased occurrence of the thalamo-visuo-motor network, suggesting a compensatory pathophysiological trait. Clinical improvement after SRS-T was related to changes in occurrences of the basal ganglia and extrastriate cortex circuitry, which returned to HC values after the intervention, suggesting that the dynamics of the extrastriate cortex had a role in tremor generation and further arrest after the intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The data in this study point to a broader implication of the visual system in tremor generation, and not only through visual feedback, given its connections to the dorsal visual stream pathway and the cerebello-thalamo-cortical circuitry, with which its dynamic balance seems to be a crucial feature for reduced tremor. Furthermore, SRS-T seems to bring abnormal pretherapeutic connectivity of the extrastriate cortex to levels comparable to those of HC subjects.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2019.2.jns183454","type":"journal-article","created":{"date-parts":[[2021,8,23]],"date-time":"2021-08-23T12:52:53Z","timestamp":1629723173000},"page":"1792-1801","source":"Crossref","is-referenced-by-count":20,"title":["Normalization of aberrant pretherapeutic dynamic functional connectivity of extrastriate visual system in patients who underwent thalamotomy with stereotactic radiosurgery for essential tremor: a resting-state functional MRI study"],"prefix":"10.3171","volume":"132","author":[{"given":"Constantin","family":"Tuleasca","sequence":"first","affiliation":[{"name":"Service de Neurochirurgie, Assistance Publique-H\u00f4pitaux de Paris, H\u00f4pitaux Universitaires Paris-Sud, Centre Hospitalier Universitaire de Bic\u00eatre, Paris;"},{"name":"Facult\u00e9 de M\u00e9decine, Sorbonne Universit\u00e9, Paris, France;"},{"name":"Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne;"},{"name":"Medical Image Analysis Laboratory and Department of Radiology\u2013Center of Biomedical Imaging, Centre Hospitalier Universitaire Vaudois, Lausanne;"},{"name":"Signal Processing Laboratory (LTS 5), \u00c9cole Polytechnique F\u00e9d\u00e9rale de Lausanne;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas A. 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