From Velasco to NAUTILUS: an evolution of centromedian nucleus targeting in epilepsy

Clemens Neudorfer, Pranav Nanda, and colleagues review the evolution of centromedian nucleus (CM) targeting for epilepsy in the Journal of Neurosurgery, tracing the field from Velasco’s early stereotactic approaches to modern image-guided surgery. Because the precision of electrode placement determines whether stimulation engages the intended thalamocortical circuits, the review details the MRI-based, atlas-informed targeting workflow used across sites of the recently completed NAUTILUS trial of CM stimulation. It provides practical tools that let clinicians reproduce this methodology, accommodating both direct visualization and atlas-based planning when imaging is suboptimal. The result is a reproducible framework intended to standardize CM targeting and support future location-based analysis of outcomes.