[Anterior Thalamic Deep Brain Stimulation Therapy Based on Functional Anatomy].

Deep brain stimulation (DBS) targets the anterior nucleus of the thalamus (ANT), and has emerged as a promising treatment for drug-resistant epilepsy. ANT-DBS is thought to exert its antiepileptic effect by activating inhibitory interneurons in the cingulate gyrus, thereby modulating epileptic activity through the Papez circuit and default mode network, both major components of the limbic system. Among the ANT subnuclei, the anteroventral nucleus (AV) is considered the most promising stimulation site because of its extensive connectivity with the limbic system. However, direct visualization of the AV nucleus using MRI is challenging. In contrast, the ANT-mammillothalamic tract (MTT) junction is clearly identifiable on imaging, and serves as a practical landmark for targeting. There are two major surgical approaches for ANT-DBS: transventricular and extraventricular. Thus, the transventricular approach may offer superior electrode placement accuracy. As increasing evidence indicates that seizure outcomes are more closely related to the precise stimulation site than to stimulation parameters, image-guided targeting based on the ANT-MTT junction is considered critically important for optimizing clinical outcomes.