Gamma Knife Thalamotomy for Essential Tremor: A Retrospective Analysis
Gamma Knife Thalamotomy for Essential Tremor: A Retrospective Analysis
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伽玛刀丘脑切除术治疗特发性震颤：回顾性分析
DOI：
10.1016/j.wneu.2023.03.033
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发表时间：
2023
影响因子：
2
通讯作者：
Takaomi Taira 2
中科院分区：
文献类型：
--
作者：
Shiro Horisawa 1;Motohiro Hayashi 2;Noriko Tamura 2;Kotaro Kohara 2;Taku Nonaka 2;Tomoko Hanada 3;Takakazu Kawamata 2;Takaomi Taira 2
背景伽玛刀（GK）丘脑切开术已被用作特发性震颤（ET）的治疗选择。许多关于GK用于ET治疗的研究报告了更多不同的反应和并发症发生率。方法回顾性分析27例行GK丘脑切开术的ET患者的资料。采用Fahn-Tolosa-Marin临床评定量表评估震颤、书写和螺旋绘画。术后不良事件和磁共振成像结果也进行了评估。结果GK切除的平均年龄为78.1±4.2岁。平均随访32.5±19.4个月。术前体位震颤、书写和螺旋画评分分别为3.4±0.6、3.3±1.0和3.2±0.8，在可获得的最终随访评估中，均有显著改善，分别为1.5±1.2（改善55.9%，P< 0.001）、1.4±1.1（改善57.6%，P< 0.001）和1.6±1.3（改善50%，P< 0.001）。3例患者表现为震颤无改善。6例患者在最后随访期间出现不良反应，包括完全性偏瘫、足部无力、构音障碍、吞咽困难、唇部麻木和手指麻木。2例患者出现严重并发症，包括大面积水肿引起的完全性偏瘫和慢性囊性扩张血肿。1例患者死于慢性囊性扩张血肿继发严重吞咽困难后的吸入性肺炎。结论sgk丘脑切开术是治疗ET的有效方法，但需精心制定治疗方案，以减少并发症的发生。对放射并发症的预测将提高GK治疗的安全性和有效性。
BackgroundGamma knife (GK) thalamotomy has been used as a treatment option for essential tremor (ET). Numerous studies on GK use in ET treatment have reported more varied responses and complication rates.MethodsData from 27 patients with ET who underwent GK thalamotomy were retrospectively analyzed. The Fahn-Tolosa-Marin Clinical Rating Scale for Tremor, handwriting, and spiral drawing were evaluated. Postoperative adverse events and magnetic resonance imaging findings were also evaluated.ResultsThe mean age at GK thalamotomy was 78.1 ± 4.2 years. The mean follow-up period was 32.5 ± 19.4 months. The preoperative postural tremor, handwriting, and spiral drawing scores were 3.4 ± 0.6, 3.3 ± 1.0, and 3.2 ± 0.8, respectively, all of which showed significant improvements to 1.5 ± 1.2 (55.9% improvement,P< 0.001), 1.4 ± 1.1 (57.6% improvement,P< 0.001), and 1.6 ± 1.3 (50% improvement,P< 0.001), respectively, at the available final follow-up evaluations. Three patients presented with no improvement in tremor. Six patients presented with adverse effects, including complete hemiparesis, foot weakness, dysarthria, dysphagia, lip numbness, and finger numbness, at the final follow-up period. Two patients presented with serious complications, including complete hemiparesis due to massive widespread edema and chronic encapsulated expanding hematoma. One patient died of aspiration pneumonia following severe dysphagia secondary to chronic encapsulated expanding hematoma.ConclusionsGK thalamotomy is an efficient procedure for treating ET. Careful treatment planning is necessary to reduce complication rates. The prediction of radiation complications will increase the safety and effectiveness of GK treatment.