Posteroventral pallidotomy for midbrain tremor after a pontine hemorrhage - Case report
Posteroventral pallidotomy for midbrain tremor after a pontine hemorrhage - Case report
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DOI：
10.3171/jns.1999.91.5.0885
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发表时间：
1999-11-01
影响因子：
4.1
通讯作者：
Kamikaseda, K
中科院分区：
文献类型：
--
作者：
Miyagi, Y;Shima, F;Kamikaseda, K
这位49岁的男性在遭受脑桥被盖出血8个月后，逐渐出现右侧上肢近端的致残性动作震颤。术中在左侧丘脑腹侧中间核(VIM)的显微记录显示震颤-同步分组放电，主要在肩部和上臂有强烈的动作震颤(2.7赫兹)。VIM中的高频电刺激不影响震颤。行腹后苍白球切开术(PVP)，成功缓解所有震颤活动。苍白球腹后切开术可以减轻帕金森病患者的震颤，尤其是发生在对侧下肢、躯干和上肢近端的震颤。作者认为PAL脂网通路是上肢近端震颤的重要通路，PVP可比VIM丘脑切除术更有效地控制PAL脂网通路，本例中脑震颤的消退就证明了这一点。
This 49-year-old man gradually developed a disabling action tremor in the proximal right upper extremity 8 months after suffering a pontine tegmental hemorrhage. The intraoperative microrecording in the nucleus ventralis intermedius (VIM) of the left thalamus revealed tremor-synchronous grouped discharges with a vigorous (2.7 Hz) action tremor predominantly in the shoulder and upper arm. High frequency electrical stimulation in the VIM did not affect the tremor. A posteroventral pallidotomy (PVP) was performed and resulted in the successful alleviation of all tremor activity. Posteroventral pallidotomy is known to alleviate parkinsonian tremors, especially those occurring in the contralateral lower extremity, trunk, and proximal segment of the contralateral upper extremity. The authors consider the pal lidoreticular pathway to be an important tremor-mediating pathway for the proximal segment of the upper extremities and believe it can be controlled more effectively by PVP than by VIM thalamolomy, as demonstrated by the PVP-induced resolution of the midbrain tremor observed in this case.