The rubral wing and its connectome

Purpose: Imaging developments optimizing stereotactic surgery for tremor have yielded white matter attenuating sequences (FGATIR/FLAWS) showing a targetable hypointensity in the subthalamic region (rubral wing, RW). RW has been reported to coincide with yet to be defined portions of the dentato-rubr...

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Main Authors: Volker A. Coenen, Alexander Rau, Horst Urbach, Bastian E.A. Sajonz, Marco Reisert
Format: Article
Language:English
Published: Elsevier 2025-01-01
Series:NeuroImage: Clinical
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Online Access:http://www.sciencedirect.com/science/article/pii/S2213158225001196
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author Volker A. Coenen
Alexander Rau
Horst Urbach
Bastian E.A. Sajonz
Marco Reisert
author_facet Volker A. Coenen
Alexander Rau
Horst Urbach
Bastian E.A. Sajonz
Marco Reisert
author_sort Volker A. Coenen
collection DOAJ
description Purpose: Imaging developments optimizing stereotactic surgery for tremor have yielded white matter attenuating sequences (FGATIR/FLAWS) showing a targetable hypointensity in the subthalamic region (rubral wing, RW). RW has been reported to coincide with yet to be defined portions of the dentato-rubro-thalamic tract (DRT). Its discernibility on the single subject level might be hampered by low signal-to-noise ratio (SNR), potentially compromising with surgical outcomes. We here set out to investigate RW as a target structure for tremor surgery by further characterizing it volumetrically and with tractography. Methods: We performed manual delineations of RW on FLAWS sequences (n = 77, 3 raters) and warped results into MNI 152. We performed tractographic analyses of DRT (human connectome project body, n = 1000), using the red nuclei and RW as waypoints. Further, we investigated fiber tightness peaks of crossed (DRTx) and uncrossed DRT portions (DRTu) along their z-axis. Results: Identification of RW was possible in all subjects. DICE coefficient for volumetric comparison was rather low with 0.54. Euclidean distance of the RW centers of gravity (COG) was <2 mm. RW defines DRTx and optimally routes fibers to the precentral gyrus (PCG). A tightness peak for fibers descending from PCG (DRTx only) was found to coincide with RW. Conclusions: RW potentially represents a valid candidate target for tremor surgery and is part of the post-crossing portion of the DRTx. COG of RW can be determined with good accuracy, but full volumetric appreciation is difficult on the single subject level (SNR), potentially necessitating additional imaging for surgical targeting.
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spelling doaj-art-849052b3680b438fa77def4d4ed1a77e2025-08-20T03:55:54ZengElsevierNeuroImage: Clinical2213-15822025-01-014810384910.1016/j.nicl.2025.103849The rubral wing and its connectomeVolker A. Coenen0Alexander Rau1Horst Urbach2Bastian E.A. Sajonz3Marco Reisert4Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany; Medical Faculty of Freiburg University, Germany; Center for Deep Brain Stimulation, Medical Center of Freiburg University, GermanyDepartment of Neuroradiology, Medical Center – University of Freiburg, Germany; Medical Faculty of Freiburg University, GermanyDepartment of Neuroradiology, Medical Center – University of Freiburg, Germany; Medical Faculty of Freiburg University, GermanyDepartment of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany; Medical Faculty of Freiburg University, Germany; Center for Deep Brain Stimulation, Medical Center of Freiburg University, GermanyDepartment of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany; Medical Faculty of Freiburg University, Germany; Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center – University of Freiburg, Germany; Corresponding author at: Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher Straße 64, 79106 Freiburg i.Br., Germany.Purpose: Imaging developments optimizing stereotactic surgery for tremor have yielded white matter attenuating sequences (FGATIR/FLAWS) showing a targetable hypointensity in the subthalamic region (rubral wing, RW). RW has been reported to coincide with yet to be defined portions of the dentato-rubro-thalamic tract (DRT). Its discernibility on the single subject level might be hampered by low signal-to-noise ratio (SNR), potentially compromising with surgical outcomes. We here set out to investigate RW as a target structure for tremor surgery by further characterizing it volumetrically and with tractography. Methods: We performed manual delineations of RW on FLAWS sequences (n = 77, 3 raters) and warped results into MNI 152. We performed tractographic analyses of DRT (human connectome project body, n = 1000), using the red nuclei and RW as waypoints. Further, we investigated fiber tightness peaks of crossed (DRTx) and uncrossed DRT portions (DRTu) along their z-axis. Results: Identification of RW was possible in all subjects. DICE coefficient for volumetric comparison was rather low with 0.54. Euclidean distance of the RW centers of gravity (COG) was <2 mm. RW defines DRTx and optimally routes fibers to the precentral gyrus (PCG). A tightness peak for fibers descending from PCG (DRTx only) was found to coincide with RW. Conclusions: RW potentially represents a valid candidate target for tremor surgery and is part of the post-crossing portion of the DRTx. COG of RW can be determined with good accuracy, but full volumetric appreciation is difficult on the single subject level (SNR), potentially necessitating additional imaging for surgical targeting.http://www.sciencedirect.com/science/article/pii/S2213158225001196Rubral wingTremorDeep brain stimulationFGATIR sequenceFLAWS sequenceHigh intensity focused ultrasound
spellingShingle Volker A. Coenen
Alexander Rau
Horst Urbach
Bastian E.A. Sajonz
Marco Reisert
The rubral wing and its connectome
NeuroImage: Clinical
Rubral wing
Tremor
Deep brain stimulation
FGATIR sequence
FLAWS sequence
High intensity focused ultrasound
title The rubral wing and its connectome
title_full The rubral wing and its connectome
title_fullStr The rubral wing and its connectome
title_full_unstemmed The rubral wing and its connectome
title_short The rubral wing and its connectome
title_sort rubral wing and its connectome
topic Rubral wing
Tremor
Deep brain stimulation
FGATIR sequence
FLAWS sequence
High intensity focused ultrasound
url http://www.sciencedirect.com/science/article/pii/S2213158225001196
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