TY - JOUR T1 - Connectomic Basis for Tremor Control in Stereotactic Radiosurgical Thalamotomy JF - American Journal of Neuroradiology JO - Am. J. Neuroradiol. DO - 10.3174/ajnr.A7778 AU - E.H. Middlebrooks AU - R.A. Popple AU - E. Greco AU - L. Okromelidze AU - H.C. Walker AU - D.A. Lakhani AU - A.R. Anderson AU - E.M. Thomas AU - H.D. Deshpande AU - B.A. McCullough AU - N.P. Stover AU - V.W. Sung AU - A.P. Nicholas AU - D.G. Standaert AU - T. Yacoubian AU - M.N. Dean AU - J.A. Roper AU - S.S. Grewal AU - M.T. Holland AU - J.N. Bentley AU - B.L. Guthrie AU - M. Bredel Y1 - 2023/01/26 UR - http://www.ajnr.org/content/early/2023/01/25/ajnr.A7778.abstract N2 - BACKGROUND AND PURPOSE: Given the increased use of stereotactic radiosurgical thalamotomy and other ablative therapies for tremor, new biomarkers are needed to improve outcomes. Using resting-state fMRI and MR tractography, we hypothesized that a “connectome fingerprint” can predict tremor outcomes and potentially serve as a targeting biomarker for stereotactic radiosurgical thalamotomy.MATERIALS AND METHODS: We evaluated 27 patients who underwent unilateral stereotactic radiosurgical thalamotomy for essential tremor or tremor-predominant Parkinson disease. Percentage postoperative improvement in the contralateral limb Fahn‐Tolosa‐Marin Clinical Tremor Rating Scale (TRS) was the primary end point. Connectome-style resting-state fMRI and MR tractography were performed before stereotactic radiosurgery. Using the final lesion volume as a seed, “connectivity fingerprints” representing ideal connectivity maps were generated as whole-brain R-maps using a voxelwise nonparametric Spearman correlation. A leave-one-out cross-validation was performed using the generated R-maps.RESULTS: The mean improvement in the contralateral tremor score was 55.1% (SD, 38.9%) at a mean follow-up of 10.0 (SD, 5.0) months. Structural connectivity correlated with contralateral TRS improvement (r = 0.52; P  = .006) and explained 27.0% of the variance in outcome. Functional connectivity correlated with contralateral TRS improvement (r = 0.50; P  = .008) and explained 25.0% of the variance in outcome. Nodes most correlated with tremor improvement corresponded to areas of known network dysfunction in tremor, including the cerebello-thalamo-cortical pathway and the primary and extrastriate visual cortices.CONCLUSIONS: Stereotactic radiosurgical targets with a distinct connectivity profile predict improvement in tremor after treatment. Such connectomic fingerprints show promise for developing patient-specific biomarkers to guide therapy with stereotactic radiosurgical thalamotomy.BOLDblood oxygen level–dependent MRIDBSdeep brain stimulationDRTTdentato-rubro-thalamic tractSMSsimultaneous multisliceSRSstereotactic radiosurgeryTRSFahn‐Tolosa‐Marin Clinical Tremor Rating ScaleVIMventral intermediate nucleus ER -