title: Caudal Zona Incerta/VOP Radiofrequency Lesioning Guided by Combined Stereotactic MRI and Microelectrode Recording for Posttraumatic Midbrain Resting-Kinetic Tremor.
abstract: OBJECTIVE
  Reporting the outcome of two patients who underwent unilateral ablative stereotactic surgery to treat pharmacologic resistant posttraumatic tremor (PTT).
  
  
  METHODS
  We present two patients (31 and 47 years old) with refractory PTT severely affecting their quality of life. Under stereotactic guidance, refined by T2-weighted magnetic resonance imaging and double-channel multiunit microelectrode recording (MER), three sequential radiofrequency lesions were performed in the caudal zona incerta (cZi) up to the base of thalamus (VOP). Effects of cZi/VOP lesion were prospectively rated with a tremor rating scale.
  
  
  RESULTS
  Both patients demonstrated intraoperative tremor suppression with sustained results up to 18 months follow-up, with improvement of 92% and 84%, respectively, on the tremor rating scale. Tremor improvement was associated with enhancement functionality and quality of life for the patients. The patients returned to their work after the procedure. No adverse effects were observed up to the last follow-up.
  
  
  CONCLUSIONS
  Radiofrequency lesion of the cZi/VOP target was effective for posttraumatic tremor in both cases. The use of T2-weighted images and MER was found helpful in increasing the precision and safety of the procedure, because it leads the RF probe by relying on neighbor structures based on thalamus and subthalamic nucleus.
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry at Hospital das Clínicas of University of São Paulo Medical School.
authors.forename: William Omar
authors.initials: WO
authors.lastname: Contreras Lopez
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry at Hospital das Clínicas of University of São Paulo Medical School.
authors.forename: Angelo R
authors.initials: AR
authors.lastname: Azevedo
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry at Hospital das Clínicas of University of São Paulo Medical School.
authors.forename: Rubens G
authors.initials: RG
authors.lastname: Cury
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry at Hospital das Clínicas of University of São Paulo Medical School.
authors.forename: Francisco
authors.initials: F
authors.lastname: Alencar
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry at Hospital das Clínicas of University of São Paulo Medical School.
authors.forename: Iuri S
authors.initials: IS
authors.lastname: Neville
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry at Hospital das Clínicas of University of São Paulo Medical School.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Reis
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry at Hospital das Clínicas of University of São Paulo Medical School.
authors.forename: Jessie
authors.initials: J
authors.lastname: Navarro
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry at Hospital das Clínicas of University of São Paulo Medical School.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Monaco
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry at Hospital das Clínicas of University of São Paulo Medical School.
authors.forename: Fabio E Fernandes
authors.initials: FE
authors.lastname: da Silva
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry at Hospital das Clínicas of University of São Paulo Medical School.
authors.forename: Manoel J
authors.initials: MJ
authors.lastname: Teixeira
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry at Hospital das Clínicas of University of São Paulo Medical School. Electronic address: erich.fonoff@gmail.com.
authors.forename: Erich T
authors.initials: ET
authors.lastname: Fonoff
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008839:Microelectrodes; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011846:Radio Waves; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D062707:Return to Work; D020531:Subthalamic Nucleus / Q000033:anatomy & histology / Q000601:surgery; D013788:Thalamus / Q000601:surgery*; D016896:Treatment Outcome; D014202:Tremor / Q000209:etiology / Q000601:surgery*; D065820:Zona Incerta / Q000601:surgery*
keywords: Ablative radiofrequency surgery; Deep brain stimulation; Diffuse axonal injury; Forel's fields; Microelectrode recording; Traumatic brain injury; Tremor; Zona incerta