PMC9798537_01
Preoperative images of her MRI. (A) T2 image taking before FUS:thalamotomy after right thalamic infarction (yellow arrow). The infarction was located in the right VC extending to the pulvinar nucleus. (B) T2 image taking a day after FUS:thalamotomy. Note that the lesion with super low intensity with surrounding high intensity was located in the Vim (red arrow). (C) High magnification of B. FUS, focused ultrasound surgery; MRI, magnetic resonance imaging; VC, ventral caudalis nucleus; Vim, ventral intermediate nucleus.
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F1
We present the case of a right-handed 77-year-old female patient who developed a right thalamic infarction at the age of 74 years (Figure 1A). Magnetic resonance imaging (MRI) revealed a small, old infarction in the ventral-posterolateral area of the thalamus, which was mainly consistent with the ventral caudalis (VC) and the pulvinar nucleus (Figure 1A). The maximum average temperature was 54 C, and the location of the lesion was considered appropriate (Figures 1B, C). Surgical planning was performed using a planning workstation, Voxim (Renishaw, New Mills, UK) (Supplementary Figures S1A-D). The postoperative course was uneventful, and imaging studies, including radiography (Supplementary Figures S1E, F) and computed tomography, demonstrated the optimal location of leads without complications.
A schema shows the lead targeting the Vo/Zi superimposed on the atlas, which is adopted from the stereotaxy atlas (14). The yellow circle represents the initial target. Red circle represents the location of the MC. Black broken line is transparent image of the other lead. AC, anterior commissure; IC, internal capsule; MC, midpoint of AC-PC line; PC, posterior commissure; Raprl, prelemniscal radiation; STN, subthalamic nucleus; VC, ventral caudalis; Vop (a, i), ventral oralis nucleus posterior (anterior, interna); Zi, zona incerta.
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F2
Accordingly, we planned dual-lead DBS; one target was the Vo + Zi (Figure 2), and the other target was Vim + Raprl (Figure 3). The angle to the AC-PC plane was 46  and the angle from the midline was 26  (Figure 2). The contacts 1 to 4 were in the Zi, and 5 to 8 were in the Vo (Figure 2).
A schema shows the lead targeting the Vim/Raprl superimposed on the atlas, which is adopted from the stereotaxy atlas (Schaltenbrand and Wahren,). The yellow circle is the initial target. Red circle is the location of the MC. Black broken line is transparent image of the other lead. AC, anterior commissure; IC, internal capsule; MC, midpoint of AC-PC line; PC, posterior commissure; Raprl, prelemniscal radiation; STN, subthalamic nucleus; VC, ventral caudalis; Vop (a), ventral oralis nucleus posterior (anterior); Zi, zona incerta.
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F3
Accordingly, we planned dual-lead DBS; one target was the Vo + Zi (Figure 2), and the other target was Vim + Raprl (Figure 3). The angle to the AC-PC plane was 65 , and the angle from the midline was 19  (Figure 3). The contacts 1 to 4 were in the Raprl, and 5 to 8 were in the Vim (Figure 3).