Abstract
Considerable positive experience in functional radiosurgery has been reported since Leksell’s first experience in 1951, but the development of frameless radiosurgery was been limited because of the difficulty of identifying invisible functional targets. In this paper we report on two cases of bilateral parkinsonian tremor successfully treated with DBS on one side and with frameless radiosurgery on the contralateral side. We focus on the methodology developed to define the three-dimensional target coordinates for frameless radiosurgery. Two patients suffering from a disabling upper-limb parkinsonian tremor underwent frameless radiosurgical thalamotomy. To accurately identify the treatment target the CT gantry was treated as a stereotactic frame; a rototranslation between the origin of the screen and the origin of the stereotactic atlas allowed us to obtain atlas-registered 3D coordinates of each point on the CT axial brain slices. Both patients achieved complete bilateral tremor control by unilateral radiosurgery and contralateral DBS. We developed a method for determining the 3D coordinates of a known functional target to treat with frameless radiosurgery. Based on the initial experiences, frameless radiosurgery appears to be an alternative treatment for Parkinsonian upper limb tremor in the presence of increased surgical risks for DBS placement.
Reference
Adler JR Jr, Chang SD, Murphy MJ, Doty J, Jeis P, Hancock SL (1997) The Cyberknife: a frameless robotic system for radiosurgery. Stereotact Funct Neurosurg 69:124–128
Adler JR Jr, Murphy MJ, Chang SD, Hancock SL (1999) Image guided robotic radiosurgery. Neurosurgery 44:1299–1307
Adler JR Jr, Bower R, Gupta G, Lim M, Efron A, Gibbs IC, Chang SD, Soltys SG (2009) Nonisocentric radiosurgical rhizotomy for trigeminal neuralgia. Neurosurgery 64(2 Suppl):A84–A90
Alvarez L, Macias R, Lopez G, Alvarez E, Pavon N, Rodriguez-Oroz MC, Juncos JL, Maragoto C, Guridi J, Litvan I, Tolosa ES, Koller W, Vitek J, DeLong MR, Obeso JA (2005) Bilateral subthalamotomy in Parkinson’s disease: initial and long-term response. Brain 128(Pt 3):570–583
Benabid AL, Chabardes S, Mitrofanis J, Pollak P (2009) Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson’s disease. Lancet Neurol 8(1):67–81
Chang SD, Main W, Martin DP, Gibbs IC, Heilbrun MP (2003) An analysis of the accuracy of the Cyberknife: a robotic frameless stereotactic radiosurgery system. Neurosurgery 52:140–147
Colombo F, Cavedon C, Casentini L, Francescon P, Causin F, Pinnna V (2009) Early results of CyberKnife radiosurgery for arteriovenous malformations. J Neurosurg 111:807–819
Duma CM, Jaques DB, Kopyov OV, Mark R, Copcutt B, Farokhi H (1998) Gamma knife radiosurgery for thalamotomy in parkinsonian tremor: a five years experience. J Neurosurg 88:1044–1049
Fariselli L, Marras C, De Santis M, Marchetti M, Milanesi I, Broggi G (2009) CyberKnife radiosurgery as a first treatment for idiopathic trigeminal neuralgia. Neurosurgery 64(2 Suppl):A96–A101
Friedman DP, Goldman HW, Flanders AE, Gollomp SM, Curran WJ Jr (1999) Stereotactic radiosurgical pallidotomy and thalamotomy with the gamma knife: MR imaging findings with clinical correlation–preliminary experience. Radiology 212(1):143–150
Frighetto L, De Salles A, Wallace R, Ford J, Selch M, Cabatan-Awang C, Solberg T (2004) Linear accelerator thalamotomy. Surg Neurol 62(2):106–113, discussion 113-4
Hariz MI, Rehncrona S, Quinn NP et al. (2008) Multicentre advanced Parkinson’s disease deep brain stimulation group. Multicenter study on deep brain stimulation in Parkinson’s disease: an independent assessment of reported adverse events at 4 years. Mov Disord 23(3):416–21
Leksell L (1951) The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 102(4):316–319
Lindquist C, Kihlstrom L, Hellstrand E (1991) Functional neurosurgery–a future for the gamma knife? Stereotact Funct Neurosurg 57(1–2):72–81
Mathieu D, Kondziolka D, Niranjan A, Flickinger J, Lunsford LD (2007) Gamma knife thalamotomy for multiple sclerosis tremor. Surg Neurol 68(4):394–399
Oh MY, Hodaie M, Kim SH, Alkhani A, Lang AE, Lozano AM (2001) Deep brain stimulator electrodes used for lesioning: proof of principle. Neurosurgery 49(2):363–367
Ohye C (2006) From selective thalamotomy with microrecording to gamma thalamotomy for movement disorders. Stereotact Funct Neurosurg 84(4):155–161
Ohye C, Shibazaki T, Ishihara J, Zhang J (2000) Evaluation of gamma thalamotomy for parkinsonian and other tremors: survival of neurons adjacent to the thalamic lesion after gamma thalamotomy. J Neurosurg 93(Suppl 3):120–127
Ohye C, Shibazaki T, Sato S (2005) Gamma knife thalamotomy for movement disorders: evaluation of the thalamic lesion and clinical results. J Neurosurg 102(Suppl):234–240
Stacy MA, Elble RJ, Ondo WG, Wu SC, Hulihan J (2007) Assessment of interrater and intrarater reliability of the Fahn-Tolosa-Marin Tremor Rating Scale in essential tremor. Mov Disord 22(6):833–838
Svennilson E, Torvik A, Lowe R, Leksell L (1960) Treatment of parkinsonism by stereotactic thermolesions in the pallidal region. A clinical evaluation of 81 cases. Acta Psychiatr Scand 35:358–377
Tripoliti E, Zrinzo L, Martinez-Torres I, Tisch S, Frost E, Borrell E, Hariz MI, Limousin P (2008) Effects of contact location and voltage amplitude on speech and movement in bilateral subthalamic nucleus deep brain stimulation. Mov Disord 23(16):2377–2383
Villavicencio AT, Lim M, Burneikiene S, Romanelli P, Adler JR, McNeely L, Chang SD, Fariselli L, McIntyre M, Bower R, Broggi G, Thramann JJ (2008) Cyberknife radiosurgery for trigeminal neuralgia treatment: a preliminary multicenter experience. Neurosurgery 62(3):647–655
Young RF, Vermeulen SS, Grimm P, Posewitz AE, Jacques DB, Rand RW, Copcutt BG (1995) Gamma Knife thalamotomy for the treatment of persistent pain. Stereotact Funct Neurosurg 64(Suppl 1):172–181
Young RF, Shumway-Cook A, Vermeulen SS, Grimm P, Blasko J, Posewitz A, Burkhart WA, Goiney RC (1998) Gamma knife radiosurgery as a lesioning technique in movement disorder surgery. J Neurosurg 89(2):183–193
Young RF, Jacques S, Mark R, Kopyov O, Copcutt B, Posewitz A, Li F (2000) Gamma knife thalamotomy for treatment of tremor: long-term results. J Neurosurg 93(Suppl 3):128–135
Yu C, Main W, Taylor D, Kuduvalli G, Apuzzo LJ, Adler JR, Wang MY (2004) An anthropomorphic phantom study of the accuracy of cyberknife radiosurgery. Neurosurgery 55(5):1138–1149
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The authors wish to thank Dr. David W. Schaal, Accuray Incorporated, for technical and editorial assistance.
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The authors have no financial interest in the instruments presented in this manuscript.
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Franzini, A., Marchetti, M., Brait, L. et al. Deep brain stimulation and frameless stereotactic radiosurgery in the treatment of bilateral parkinsonian tremor: target selection and case report of two patients. Acta Neurochir 153, 1069–1075 (2011). https://doi.org/10.1007/s00701-011-0962-0
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DOI: https://doi.org/10.1007/s00701-011-0962-0