title: Effects of electrode implantation angle on thalamic stimulation for treatment of tremor.
abstract: Introduction. Chronic thalamic stimulation has been confirmed as an effective treatment for tremor. The optimal target has been commonly accepted to be situated within the ventral thalamus, but a standard trajectory of the deep brain stimulation (DBS) electrode has not yet been established. Materials and Methods. A 53-year-old man with an 11-year history of essential tremor was treated by DBS of the thalamus. In this patient, we had a chance to compare the effects of different trajectory angles of the DBS electrode on tremor. Results. Intraoperative stimulation with the DBS electrode temporarily inserted at a high angle to the horizontal plane of the anterior commissure-posterior commissure (AC-PC) line to cover only the nucleus ventralis intermedius (Vim) was not effective. In contrast, stimulation with the DBS electrode permanently implanted at a low angle, covering a wide area extending from the nucleus ventralis oralis (Vo) to the Vim, reduced the tremor. Conclusion. We report on the case of a patient who showed different effects on tremor depending on the trajectory angle of the DBS electrode to the AC-PC line. The insertion trajectory of the DBS electrode may be an important factor for the treatment of tremor.
authors: Department of Neurological Surgery and              Division of Applied System Neuroscience, Department of Advanced Medical Science, Nihon University School of Medicine, Tokyo, Japan; and              Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors: Kazutaka
authors: K
authors: Kobayashi
authors: Yoichi
authors: Y
authors: Katayama
authors: Koichiro
authors: K
authors: Sumi
authors: Toshiharu
authors: T
authors: Otaka
authors: Toshiki
authors: T
authors: Obuchi
authors: Toshikazu
authors: T
authors: Kano
authors: Takafumi
authors: T
authors: Nagaoka
authors: Hideki
authors: H
authors: Oshima
authors: Chikashi
authors: C
authors: Fukaya
authors: Takamitsu
authors: T
authors: Yamamoto
authors: Hideki
authors: H
authors: Atsumi