Tag: pulvinar

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Multinuclear thalamic targeting with human stereotactic electroencephalography

J Neurosurg 142:936–944, 2025

The study details a novel stereotactic electroencephalography (sEEG) approach targeting thalamic nuclei for personalized epilepsy treatment. It describes surgical techniques for sampling thalamic regions, aiming to improve neuromodulation strategies. The focus is on minimizing electrodes and maximizing cortical and subcortical coverage.

Multinuclear Thalamic Targeting with sEEG

• Novel sEEG approach identifies personalized seizure networks in the thalamus.

• Multilead orthogonal and trans-massa intermedia trajectories efficiently sample thalamic nuclei.

• Long-axis trajectory samples lateral PLV, MD, and ANT with a single electrode.

• Approaches resulted in no complications in 34 patients.

• Thalamic nuclei are crucial for neuromodulation in refractory epilepsy.

• DBS of thalamic nuclei shows heterogeneous patient responses.

Surgical Techniques and Trajectories

• Orthogonal trajectories maximize mediolateral thalamic coverage.

• Trans-massa intermedia approach samples bilateral MD nuclei with a single electrode.

• Long-axis trajectory samples ANT, MD, and PLV in a single plane.

• Extraventricular trajectories optimize thalamic coverage and safety.

Patient Selection and Outcomes

• 34 patients with drug-resistant epilepsy underwent sEEG implantation.

• Postoperative analysis showed millimetric accuracy in electrode placement.

• No thalamic hemorrhage or edema observed postoperatively.

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A taxonomy for deep cerebral cavernous malformations: subtypes of thalamic lesions

J Neurosurg 139:1681–1696, 2023

Anatomical taxonomy is a practical tool to successfully guide clinical decision-making for patients with brain arteriovenous malformations and brainstem cavernous malformations (CMs). Deep cerebral CMs are complex, difficult to access, and highly variable in size, shape, and position. The authors propose a novel taxonomic system for deep CMs in the thalamus based on clinical presentation (syndromes) and anatomical location (identified on MRI).

METHODS The taxonomic system was developed and applied to an extensive 2-surgeon experience from 2001 through 2019. Deep CMs involving the thalamus were identified. These CMs were subtyped on the basis of the predominant surface presentation identified on preoperative MRI. Six subtypes among 75 thalamic CMs were defined: anterior (7/75, 9%), medial (22/75, 29%), lateral (10/75, 13%), choroidal (9/75, 12%), pulvinar (19/75, 25%), and geniculate (8/75, 11%). Neurological outcomes were assessed using modified Rankin Scale (mRS) scores. A postoperative score ≤ 2 was defined as a favorable outcome and > 2 as a poor outcome. Clinical and surgical characteristics and neurological outcomes were compared among subtypes.

RESULTS Seventy-five patients underwent resection of thalamic CMs and had clinical and radiological data available. Their mean age was 40.9 (SD 15.2) years. Each thalamic CM subtype was associated with a recognizable constellation of neurological symptoms. The common symptoms were severe or worsening headaches (30/75, 40%), hemiparesis (27/75, 36%), hemianesthesia (21/75, 28%), blurred vision (14/75, 19%), and hydrocephalus (9/75, 12%). The thalamic CM subtype determined the selection of surgical approach. A single approach was associated with each subtype for most patients. The main exception to this paradigm was that in the surgeons’ early experience, pulvinar CMs were resected through a superior parietal lobule–transatrial approach (4/19, 21%), which later evolved to the paramedian supracerebellar-infratentorial approach (12/19, 63%). Relative outcomes implied by mRS scores were unchanged or improved in most patients (61/66, 92%) postoperatively.

CONCLUSIONS This study confirms the authors’ hypothesis that this taxonomy for thalamic CMs can meaningfully guide the selection of surgical approach and resection strategy. The proposed taxonomy can increase diagnostic acumen at the patient bedside, help identify optimal surgical approaches, enhance the clarity of clinical communications and publications, and improve patient outcomes.

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