Figure 1
(A–C) Axial, sagittal, and coronal high-resolution T2-weighted MRI acquired 3 days after magnetic resonance-guided focused ultrasound thalamotomy demonstrate a hyperintense lesion with central hypointensity, consistent with necrosis and surrounding edema. (D) Diffusion tractography overlay reveals proximity of the lesion to the corticospinal tract. (E–G) Follow-up imaging at 3 months shows decreased lesion size on axial, sagittal, and coronal views, respectively.
Figure 2
(A) Coronal postmortem tractography reveals preserved corticospinal tract (red) and focal disruption of the DRTT (green) at the lesion site (lesion location outlined with white line). (B) Axial postmortem tractography confirms the spatial overlap of the DRTT with the lesion and shows the preserved surrounding fibers and corticospinal tract (lesion location outlined with white line).
Figure 3
Luxol fast blue (LFB)-stained sections of the thalamus from both the left and right hemispheres. Sections progressing from anterior to posterior (A–C) were fully submitted for histopathological evaluation. On the left side in B and C, an area of demyelination corresponding with the magnetic resonance-guided focused ultrasound–treated region is revealed, outlined with black lines. Within this region, black squares indicate the specific area from which the left thalamus images in Figure 4 were obtained. The subthalamic nucleus (*) also appears pale on LFB staining. Adjacent regions of the corticospinal tract (arrows) exhibit demyelinating changes as well. Scale bar: 10 mm.
Figure 4
Histopathological evaluation of the posterior thalamus (A-J) and adjacent internal capsule (K-T). The posterior thalamus shows mild vacuolation on the left side without significant neuronal loss on hematoxylin and eosin staining (A), corresponding with the boxed area of Figure 3C (left); the right side at the same level appears normal (B). The inset in A, taken from the boxed area of Figure 3B (left), reveals a small cavitary lesion measuring approximately 1 mm. Luxol fast blue staining shows prominent demyelination on the left (C) and preserved myelin on the right (D). Glial fibrillary acidic protein staining demonstrates moderate gliosis on the left (E) compared with mild gliosis on the right (F). Neurofilimant staining indicates intact axons bilaterally (G, H). CD163 staining reveals a slightly increased number of macrophages on the left (I, J). The adjacent internal capsule (K–T) also exhibits more pronounced demyelination (M, N), increased gliosis (O, P), and greater macrophage presence (S, T) on the left compared with the right. Scale bar: 50 µm for all images.