The Surgical Approach to the Anterior Nucleus of Thalamus in Patients With Refractory Epilepsy: Experience from the International Multicenter Registry (MORE). Issue 1 (15th March 2018)

• Record Type: Journal Article
• Authors: Lehtimäki, Kai; Coenen, Volker A; Gonçalves Ferreira, Antonio; Boon, Paul; Elger, Christian; Taylor, Rod S; Ryvlin, Philippe; Gil-Nagel, Antonio; Gielen, Frans; Brionne, Thomas C; Abouihia, Abdallah; Beth, Grégory
• Is Part Of: Neurosurgery. Volume 84:Issue 1(2019)
• Page Start: 141
• Page End: 150
• Publication Date: 2018-03-15
• Subjects: Epilepsy -- Deep brain stimulation -- Anterior nucleus of thalamus -- Trajectory; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyy023
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: The Medtronic Registry for Epilepsy (MORE; Medtronic Inc, Dublin, Ireland) is an open label observational study evaluating the long-term effectiveness, safety, and performance of deep brain stimulation (DBS) of the anterior nucleus of thalamus (ANT) for the treatment of refractory epilepsy. OBJECTIVE: To compare the difference in success rate of placing contacts at ANT-target region (ANT-TR) between transventricular (TV) and extraventricular (EV) lead trajectories in 73 ANT-DBS implants in 17 European centers participating in the MORE registry. METHODS: The success rate of placing contacts at ANT-TR was evaluated using a screening method combining both individual patient imaging information and stereotactic atlas information to identify contacts at ANT-TR. RESULTS: EV lead trajectory was used in 53% of the trajectories. Approximately, 90% of the TV lead trajectories had at least 1 contact at ANT-TR, vs only 71% of the EV lead trajectories. The success rate for placing at least 1 contact at ANT-TR bilaterally was 84% for TV implants and 58% for EV implants ( P < .05; Fisher's exact). No intracranial bleedings were observed, but 1 cortical infarct was reported following EV lead trajectory. CONCLUSION: The results of this registry support the use of TV lead trajectories for ANT-DBS as they have a higher probability in placing contacts at ANT-TR, without appearing to compromise procedural safety. Follow-up data collection is continuing in the MORE registry. These data will provide outcomes associated with TV and EV trajectories.