우리 연구실 배종원 박사와 박해정 교수 장진우 교수팀은 자기공명영상 기반 집속 초음파를 이용한 수전증 환자의 시상 절제술이 시술 후 6개월 후에 예후가 좋은 그룹과 나쁜 그룹에 대해 수술전 뇌연결망을 비교 분석하는 연구로 신경외과지 1위 저널에 발표하였습니다. 85명의 환자 중 72명(84.7%)은 시상 절제술 후 6개월에 기준선에서 50% 이상의 수전증 감소를 보였습니다. 네트워크 분석은 소뇌 영역과 기저핵 및 시상 사이의 연결과 관련된 기능적 네트워크 구성 요소의 상당한 억제를 보여주지만 효과적인 그룹에 비해 비효과적인 그룹에서 전운동 피질과 보조 운동 영역 사이의 연결은 향상되었습니다. 본 연구는 비효과적인 그룹의 환자가 시상 절제술 효과가 있는 그룹에 비해 소뇌 및 피질하 영역의 기능적 하위 네트워크를 억제하고 운동 감각 피질 네트워크 간의 기능적 하위 네트워크를 강화했음을 보여줍니다. 따라서 저자는 기능적 연결 패턴이 MR 유도 집속 초음파 시상 절제술의 결과에 대한 가능한 예측 요인이 될 수 있다고 제안합니다.
Differences in intrinsic functional networks in patients with essential tremor who had good and poor long-term responses after thalamotomy performed using MR-guided ultrasound
https://doi.org/10.3171/2022.5.JNS22324
OBJECTIVE
Thalamotomy at the nucleus ventralis intermedius using MR-guided focused ultrasound has been an effective treatment method for essential tremor (ET). However, this is not true for all cases, even for successful ablation. How the brain differs in patients with ET between those with long-term good and poor outcomes is not clear. To analyze the functional connectivity difference between patients in whom thalamotomy was effective and those in whom thalamotomy was ineffective and its prognostic role in ET treatment, the authors evaluated preoperative resting-state functional MRI in thalamotomy-treated patients.
METHODS
Preoperative resting-state functional MRI data in 85 patients with ET, who were experiencing tremor relief at the time of treatment and were followed up for a minimum of 6 months after the procedure, were collected for the study. The authors conducted a graph independent component analysis of the functional connectivity matrices of tremor-related networks. The patients were divided into thalamotomy-effective and thalamotomy-ineffective groups (thalamotomy-effective group, ≥ 50% motor symptom reduction; thalamotomy-ineffective group, < 50% motor symptom reduction at 6 months after treatment) and the authors compared network components between groups.
RESULTS
Seventy-two (84.7%) of the 85 patients showed ≥ 50% tremor reduction from baseline at 6 months after thalamotomy. The network analysis shows significant suppression of functional network components with connections between the areas of the cerebellum and the basal ganglia and thalamus, but enhancement of those between the premotor cortex and supplementary motor area in the noneffective group compared to the effective group.
CONCLUSIONS
The present study demonstrates that patients in the noneffective group have suppressed functional subnetworks in the cerebellum and subcortex regions and have enhanced functional subnetworks among motor-sensory cortical networks compared to the thalamotomy-effective group. Therefore, the authors suggest that the functional connectivity pattern might be a possible predictive factor for outcomes of MR-guided focused ultrasound thalamotomy.