{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:34:29Z","timestamp":1787027669391,"version":"build-2736575974"},"reference-count":41,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,3,28]],"date-time":"2023-03-28T00:00:00Z","timestamp":1679961600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82101341"],"award-info":[{"award-number":["82101341"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["2022A1515010094"],"award-info":[{"award-number":["2022A1515010094"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["202102020366"],"award-info":[{"award-number":["202102020366"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["2022A1515010094"],"award-info":[{"award-number":["2022A1515010094"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Basic and Applied basic Research Fund Project of Guangdong Province","award":["82101341"],"award-info":[{"award-number":["82101341"]}]},{"name":"Basic and Applied basic Research Fund Project of Guangdong Province","award":["2022A1515010094"],"award-info":[{"award-number":["2022A1515010094"]}]},{"name":"Basic and Applied basic Research Fund Project of Guangdong Province","award":["202102020366"],"award-info":[{"award-number":["202102020366"]}]},{"name":"Basic and Applied basic Research Fund Project of Guangdong Province","award":["2022A1515010094"],"award-info":[{"award-number":["2022A1515010094"]}]},{"name":"Science and Technology Plan Project of Guangzhou","award":["82101341"],"award-info":[{"award-number":["82101341"]}]},{"name":"Science and Technology Plan Project of Guangzhou","award":["2022A1515010094"],"award-info":[{"award-number":["2022A1515010094"]}]},{"name":"Science and Technology Plan Project of Guangzhou","award":["202102020366"],"award-info":[{"award-number":["202102020366"]}]},{"name":"Science and Technology Plan Project of Guangzhou","award":["2022A1515010094"],"award-info":[{"award-number":["2022A1515010094"]}]},{"name":"Basic and Applied basic Research Fund Project of Guangdong Province","award":["82101341"],"award-info":[{"award-number":["82101341"]}]},{"name":"Basic and Applied basic Research Fund Project of Guangdong Province","award":["2022A1515010094"],"award-info":[{"award-number":["2022A1515010094"]}]},{"name":"Basic and Applied basic Research Fund Project of Guangdong Province","award":["202102020366"],"award-info":[{"award-number":["202102020366"]}]},{"name":"Basic and Applied basic Research Fund Project of Guangdong Province","award":["2022A1515010094"],"award-info":[{"award-number":["2022A1515010094"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background: Deep brain stimulation (DBS) is an effective surgical treatment for essential tremor (ET), with the ventral intermediate nucleus (Vim) and posterior subthalamic area (PSA) as the most common targets. The stimulation efficacy of ET with Vim\u2013PSA double-target DBS has been reported. Herein, we aim to propose surgical techniques for Vim\u2013PSA double-target DBS surgery. Methods: This study enrolled six patients with ET who underwent Vim\u2013PSA double-target electrode implantation from October 2019 to May 2022. The targets were located and adjusted using coordinates and multimodality MRI images. A burr hole was accurately drilled in line with the electrode trajectory under the guidance of a stereotactic frame. Novel approaches were adopted during the electrode implantation process for pneumocephalus reduction, including \u201carachnoid piamater welding\u201d and \u201cwater sealing\u201d. Electrophysiological recording was used to identify the implantation sites of the electrodes. A 3D reconstruction model of electrodes and nuclei was established to facilitate programming. Results: The combination of coordinates and multimodality MRI images for target location and adjustment enabled the alignment of Vim and PSA. Postoperative CT scanning showed that the electrode was precisely implanted. Stereotactic guidance facilitated accurate burr hole drilling. \u201cArachnoid piamater welding\u201d and \u201cwater sealing\u201d were efficient in reducing pneumocephalus. Intraoperative electrophysiological verified the efficacy of Vim\u2013PSA double-target DBS surgery. Conclusions: The methods for target location and adjustment, accurate drilling of the burr hole, reduction in pneumocephalus, and intraoperative electrophysiological verification are key issues in DBS surgery targeting both the Vim and PSA. This study may provide technical support for Vim\u2013PSA DBS, especially for surgeons with less experience in functional neurosurgery.<\/jats:p>","DOI":"10.3390\/brainsci13040566","type":"journal-article","created":{"date-parts":[[2023,3,28]],"date-time":"2023-03-28T02:58:21Z","timestamp":1679972301000},"page":"566","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Technical Issues of Vim\u2013PSA Double-Target DBS for Essential Tremor"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1023-8015","authenticated-orcid":false,"given":"Xusheng","family":"Hou","sequence":"first","affiliation":[{"name":"Department of Functional Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yixiang","family":"Mo","sequence":"additional","affiliation":[{"name":"Department of Functional Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyuan","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Functional Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Affiliated Hospital 2 of Nantong University and First People\u2019s Hospital of Nantong City, Nantong 226001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinzi","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihao","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, General Hospital of Xinjiang Military Command of PLA, Urumqi 830000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaozheng","family":"He","sequence":"additional","affiliation":[{"name":"Department of Functional Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan","family":"Xue","sequence":"additional","affiliation":[{"name":"Department of Functional Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangtao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, General Hospital of Xinjiang Military Command of PLA, Urumqi 830000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengqian","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Functional Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shizhong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Functional Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"l4485","DOI":"10.1136\/bmj.l4485","article-title":"Essential tremor: Diagnosis and management","volume":"366","author":"Shanker","year":"2019","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1136\/jnnp-2018-318240","article-title":"Outcomes from stereotactic surgery for essential tremor","volume":"90","author":"Dallapiazza","year":"2019","journal-title":"J. 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