Differences

This shows you the differences between two versions of the page.

--- ventral_intermediate_nucleus [2025/06/27 07:58] – administrador
+++ ventral_intermediate_nucleus [2025/06/27 08:02] (current) – administrador
@@ Line 14: / Line 14: @@
 see [[VIM Stimulation]]
 ----
-In a technical case series
-Aibar‑Duran et al.
-from:
-Hospital de la Santa Creu i Sant Pau (Barcelona), Federal University of São Paulo (São Paulo), Mass General Brigham (Boston)
-published in the journal [[Frontiers in Radiology]]
-to evaluate the feasibility of direct ventral intermediate nucleus (Vim) targeting using white matter‑null 3 T MRI (WMn‑MPRAGE) and dual‑lesion conformality during MR‑guided focused ultrasound (MRgFUS) [[thalamotomy]].
-They conclude that Direct Vim targeting with WMnMRI is feasible; postoperative imaging shows clear Vim lesions accurately avoiding internal capsule and sensory nuclei. Lesion conformality aligns with Vim anatomy. Safety and clinical outcome correlations require further study
-((Aibar-Duran JÁ, Akira Watanabe R, McDannold NJ, Cosgrove GR. New technique for direct targeting of the ventral intermediate nucleus using magnetic resonance-guided focused ultrasound. Front Radiol. 2025 Jun 11;5:1588379. doi: 10.3389/fradi.2025.1588379. PMID: 40568315; PMCID: PMC12187783.)).
-===== Content & Scientific Rigor =====
-The authors propose a novel 3 T MRI sequence (WMn‑MPRAGE) to directly identify Vim landmarks, bypassing standard indirect AC/PC coordinate targeting. Data from two patients demonstrate identifiable Vim lesions and accurate lesion geometry along the anterosuperior Vim orientation. However, a series of two cases constitutes minimal evidence. No quantitative targeting error metrics, clinical efficacy or long-term tremor outcomes are presented. There is no control group, nor comparison to standard targeting protocols or tractography-guided targeting—limiting utility and robustness.
-===== Methodology =====
-The technical description of WMn imaging and lesion conformality strategy is clear. Precise anatomical landmarks are well illustrated. Yet, the transition from atlas-based to direct targeting would benefit from standardized error measurements, inter-rater reliability, thermal dose mapping, and volumetric comparisons against existing datasets. Dual-lesion conformality rationale is logical but lacks volumetric thresholds or dose constraints.
-===== Tone & Structure =====
-The writing is concise and technically sound, but overly optimistic given limited sample size. The framing suggests generalizable feasibility, which is misleading without broader validation. Visual figures are strong, but lacking integration with clinical context. There is no explicit outline of next-phase study design or regulatory pathway.
-===== Accuracy & References =====
-The authors accurately cite prior works on 7 T MRI, tractography, and atlas-based targeting. They acknowledge limitations, though not enough emphasis is placed on proof of concept versus proof of efficacy. The sudden claim of feasibility is premature.
-===== Utility to Practicing Neurosurgeons =====
-At this stage, practicing surgeons should view this as exploratory. While WMn‑MPRAGE offers anatomical clarity on 3 T systems, its adoption should be limited to research settings. There is no evidence of improved clinical outcomes, cost-effectiveness, or workflow efficiency.
-=== Verdict & Takeaways ===
-* **Overall verdict:** Underwhelming due to minimal sample and lack of clinical outcome data.
-* **Decisive takeaway:** Direct Vim targeting at 3 T is anatomically plausible, but unvalidated in efficacy or safety.
-* **Bottom Line:** Novel imaging sequence without clinical validation—research curiosity, not clinical standard.
-* **Rating:** 3/10
-''Correspondence:''
-Juan Ángel Aibar‑Duran