The surgical approach to the anterior nucleus of thalamus in patients with refractory epilepsy: experience from the international multicenter registry (MORE)

Kai Lehtimäki (Corresponding author), Volker A. Coenen, Antonio Gonçalves Ferreira, Paul Boon, Christian Elger, Rod S. Taylor, Philippe Ryvlin, Antonio Gil-Nagel, Frans Gielen, Thomas C. Brionne, Abdallah Abouihia, Grégory Beth

Research output: Contribution to journalArticleAcademicpeer-review

15 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)141-150
Number of pages10
JournalNeurosurgery
Volume84
Issue number1
DOIs
Publication statusPublished - 1 Jan 2019

Keywords

  • Anterior nucleus of thalamus
  • Deep brain stimulation
  • Epilepsy
  • Trajectory
  • Drug Resistant Epilepsy/surgery
  • Humans
  • Registries
  • Implantable Neurostimulators
  • Deep Brain Stimulation/instrumentation
  • Anterior Thalamic Nuclei/surgery

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