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7217828 
Journal Article 
Individualized Anatomy-Based Targeting for VIM-cZI DBS in Essential Tremor 
Diaz, A; Cajigas, I; Cordeiro, JG; Mahavadi, A; Sur, S; Di Luca, DG; Shpiner, DS; Luca, CC; Jagid, JR; , 
2020 
1 
World Neurosurgery
ISSN: 1878-8750
EISSN: 1878-8769 
ELSEVIER SCIENCE INC 
NEW YORK 
E225-E233 
32438003 
WOS:000560052700030 
BACKGROUND: Deep brain stimulation of the ventral intermediate nucleus (VIM) or caudal zona incerta (cZI) is effective for refractory essential tremor (ET). To refine stereotactic planning for lead placement, we developed a unique individualized anatomy-based planning protocol that targets both the VIM and the cZI in patients with ET.METHODS: 33 patients with ET underwent VIM-cZI lead implantation with targeting based on our protocol. Indirect targeting was adjusted based on anatomic landmarks as reference lines bisecting the red nuclei and ipsilateral subthalamus. Outcomes were evaluated through the follow-up of 31.1 +/- 18.4 months. Active contact coordinates were obtained from reconstructed electrodes in the Montreal Neurological Institute space using the MATLAB LeadDBS toolbox.RESULTS: Mean tremor improvement was 79.7% +/- 22.4% and remained stable throughout the follow-up period. Active contacts at last postoperative visit had mean Montreal Neurological Institute coordinates of 15.5 +/- 1.6 mm lateral to the intercommissural line, 15.3 +/- 1.8 mm posterior to the anterior commissure, and 1.4 +/- 2.9 mm below the intercommissural plane. No hemorrhagic complications were observed in the analyzed group.CONCLUSIONS: Individualized anatomy-based VIM-cZI targeting is feasible and safe and is associated with favorable tremor outcomes.