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Article Dans Une Revue Neurosurgery Année : 2019

Metabolic Positron Emission Tomography Response to Gamma Knife of the Ventral Intermediate Nucleus in Essential Tremor

Résumé

Background: To understand the substrate of response and non-response, and identify potential biomarkers for selection and follow-up of patients with essential tremor (ET) treated by Gamma-Knife of the Ventrointermedius nucleus (GKVIM). Objective: This observational study aims to characterize PET changes in metabolism of glucose and metabolic connectivity in patients with ET treated by GKVIM. Methods: Forty-two patients with right ET were referred to 18F-FDG PET imaging before, and after left GKVIM. Statistical Parametric Mapping-T score maps comparisons were performed between pre- and post-GKVIM groups, and between clinical responders and non-responders. Metabolic connectivity was evaluated by interregional correlation analysis method. Results: After GKVIM, patients with ET exhibited a decrease of the left thalamic metabolism, associated with remote metabolic decreases in the right cerebellum, left temporal gyri, and bilateral frontal gyri (p<0.05 with family-wise error correction). Non-responders (n=7) additionally showed after GKVIM a metabolic decrease in the right temporo-occipital area (p<0.005 corrected for cluster volume). The metabolism of this area was already reduced before treatment in comparison to responders, and was predictive of the future response (sensitivity: 89 %; specificity: 71 %). In non-responder patients, a strong connectivity between the left thalamus and right temporo-occipital area was found before GKVIM and lost after treatment, while it remained weak and stable in responders. Conclusions: These findings could lead to a better knowledge of the variability of metabolic PET profiles among patients with ET, especially the integration of 18F-FDG PET imaging in the pretherapeutic evaluation of patients with refractory ET candidate to GKVIM.
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hal-02479731 , version 1 (21-04-2020)

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Antoine Verger, Tatiana Witjas, Romain Carron, Alexandre Eusebio, Emmanuelle Boutin, et al.. Metabolic Positron Emission Tomography Response to Gamma Knife of the Ventral Intermediate Nucleus in Essential Tremor. Neurosurgery, 2019, 84 (6), pp.E294-E303. ⟨10.1093/neuros/nyy340⟩. ⟨hal-02479731⟩
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