title: Tractography-guided stimulation of somatosensory fibers for thalamic pain relief.
abstract: BACKGROUND
  The spinothalamocortical tract (STC) is seen as a neural tract responsible for or involved in the generation or transmission of thalamic pain. Either the thalamus itself or the posterior limb of the internal capsule (PLIC) are targets for deep brain stimulation (DBS) in patients with thalamic pain, but due to its low contrast, conventional MRI cannot visualize the STC directly.
  
  
  OBJECTIVE
  To show the feasibility of integrating diffusion tensor imaging-based tractography into the stereotactic treatment planning for identification of an object-oriented lead trajectory that allows STC-DBS with multiple electrode contacts.
  
  
  METHODS
  Diffusion tensor imaging was performed in 4 patients with thalamic pain. The STC was modeled and integrated into the stereotactic treatment planning for DBS. DBS-lead implantation was done according to trajectory planning along the modeled STC at the level of the PLIC.
  
  
  RESULTS
  After implantation, electrode stimulation was possible over a length of more than 20 mm with a tractography-based trajectory along the PLIC part of the STC. After a follow-up of 12 months, pain relief of more than 40% was achieved in 3 of 4 patients with rating on a visual analogue scale. In 1 patient, stimulation failed to reach any long-lasting positive effects.
  
  
  CONCLUSIONS
  Integrating tractography data into stereotactic planning of DBS in thalamic pain is technically feasible. It can be used to identify a lead trajectory that allows for multiple contact stimulation along the STC at the level of the PLIC. Due to long-lasting positive stimulation effect, tractography-guided stimulation of sensory fibers seems to be beneficial for thalamic pain relief.
authors: Department of Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany.
authors: Stefan
authors: S
authors: Hunsche
authors: Dieter
authors: D
authors: Sauner
authors: Matthias J R
authors: MJ
authors: Runge
authors: Doris
authors: D
authors: Lenartz
authors: Faycal
authors: F
authors: El Majdoub
authors: Harald
authors: H
authors: Treuer
authors: Volker
authors: V
authors: Sturm
authors: Mohammad
authors: M
authors: Maarouf
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D046690:Deep Brain Stimulation / Q000379:methods*; D056324:Diffusion Tensor Imaging; D004567:Electrodes, Implanted; D005240:Feasibility Studies; D005910:Glioma / Q000532:radiotherapy; D006801:Humans; D020772:Internal Capsule / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D059906:Neuroimaging / Q000379:methods*; D010147:Pain Measurement; D010148:Intractable Pain / Q000209:etiology / Q000628:therapy*; D013133:Spinothalamic Tracts / Q000473:pathology / Q000503:physiopathology*; D013238:Stereotaxic Techniques; D020521:Stroke / Q000150:complications; D015173:Supratentorial Neoplasms / Q000532:radiotherapy; D013786:Thalamic Diseases / Q000209:etiology / Q000628:therapy*; D013813:Therapy, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome