Sequential magnetic resonance imaging following stereotactic radiofrequency ventralis lateralis thalamotomy

Abstract

Serial postoperative magnetic resonance (MR) studies were obtained in 21 patients who underwent somatotopically placed stereotactic radiofrequency (rf) ventralis lateralis thalamotomy for the control of movement disorders. The MR studies were reviewed to determine the MR characteristics of early-phase (less than or equal to 7 days) and late-phase (8 days to 5 months) lesions. Surgery was performed for the control of parkinsonian tremor (14 cases), intention tremor (six cases), and essential tremor (one case). Single rf lesions were made with an electrode (1.6 mm in diameter, 3 mm in tip length) heated to 78 degrees C for 60 seconds. On MR images of the lesions, three distinct concentric zones were identified, described as follows (from the center outward). Zone 1 gives increased signal on long-relaxation time (TR) (T2-weighted) MR images in early- and late-phase lesions and decreased signal on short-TR (T1-weighted) MR images in early-phase lesions only. Zone 2 gives decreased signal on long-TR (T2-weighted) images in early- and late-phase lesions; it gives isointense signal on short-TR (T1-weighted) images in early-phase lesions only. Zone 3 gives increased signal on long-TR (T2-weighted) images in early-phase lesions only and decreased signal on short-TR (T1-weighted) MR images in early-phase lesions only. It is considered that in early-phase lesions, Zone 2, with a mean diameter of 7.3 mm on axial long-TR (T2-weighted) imaging, represents an area of hemorrhagic coagulation necrosis. In late-phase lesions, Zone 2, with a mean diameter of 5.0 mm on axial long-TR (T2-weighted) imaging, represents hemosiderin deposition. Zone 3 likely represents edema, and this zone disappears between the early and late periods. From regression analysis, lesion size began to stabilize at approximately 7 months with a mature lesion diameter of 3.3 mm. Long-term follow-up monitoring (median 16 months) showed good tremor control. Based on clinical and radiological findings, the authors conclude that forms of hemoglobin are suitable markers to assess the size of rf lesions. Serial MR imaging provides a noninvasive means of studying the evolution of rf thalamotomy lesions.