Probabilistic Mapping of Magnetic Resonance-Guided Focused Ultrasound (MRgFUS) Thalamotomy Targets in Essential Tremor and Tremor-Dominant Parkinson's Disease: Insights from a German Cohort

Abstract

Precise targeting in magnetic resonance-guided focused ultrasound (MRgFUS) is critical for effective tremor control in essential tremor and tremor-dominant Parkinson's disease, as small deviations can reduce efficacy or cause side effects. In our cohort, sweetspots were identified at Montreal Neurological Institute (MNI) coordinates x = -12.4, y = -17.5, z = -1.7 (ET) and x = -13.4, y = -19.8, z = -3.0 (TDPD).

FIG. 1

Probabilistic mapping of clinical improvement scores and side effect voxel‐wise odds ratios (VORs). Sweetspots for tremor and functional improvement in (A + C) essential tremor (ET) (−12.4/−17.5/−1.7) and (B + D) Parkinson's disease (PD) (−13.4/−19.8/−3.0). Maps (E–J) show side effect VORs; (I) displays ET zones with good effect–risk ratio after subtracting VOR maps from sweetspot map. Key: yellow, nucleus ventro‐caudalis (VC); green, nucleus ventro orealis posterior (VOp); white, zona incerta (ZI); copper, nucleus ventralis intermedius (VIM); red, ventral posterior‐medial nucleus (VPM). FTM, Fahn–Tolosa–Marin Clinical Rating Scale. [Color figure can be viewed at wileyonlinelibrary.com]