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

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.

• Authors: Kai Lehtimäki, 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, MORE investigators
• Journal: Neurosurgery (Neurosurgery) Vol. 84 Issue 1 Pg. 141-150 (01 01 2019) ISSN: 1524-4040 [Electronic] United States
• PMID: 29554309 (Publication Type: Journal Article, Observational Study)

Topics

• Anterior Thalamic Nuclei (surgery)
• Deep Brain Stimulation (instrumentation, methods)
• Drug Resistant Epilepsy (surgery)
• Humans
• Implantable Neurostimulators
• Registries