Bilateral Magnetic Resonance Imaging-Guided Focused Ultrasound Thalamotomy for Essential Tremor
Bilateral Magnetic Resonance Imaging-Guided Focused Ultrasound Thalamotomy for Essential Tremor
复制标题
DOI：
10.1159/000518662
复制
发表时间：
2021-09-07
影响因子：
1.7
通讯作者：
Ohnishi, Hideyuki
中科院分区：
文献类型：
--
作者：
Fukutome, Kenji;Hirabayashi, Hidehiro;Ohnishi, Hideyuki
原发性震颤是成人最常见的运动障碍。双侧症状是典型的;然而，双侧丘脑切开术治疗原发性震颤与不良事件的高概率相关。我们回顾性研究了使用磁共振成像引导的聚焦超声分期双侧丘脑腹侧中间核切开术治疗难治性原发性震颤的有效性和安全性。方法：我们在2016年9月至2020年3月期间连续招募了5例难治性特发性震颤患者。患者在第一次手术后至少1年接受第二次手术。第二处病变与第一处病变不对称。结果：患者平均年龄为57.6岁，两次手术之间的平均间隔时间为27.8个月。所有患者的第二个病变中心均位于第一个病变中心的上级。平均基线、第二次术前和第二次术后震颤临床评定量表总分分别为63.6、49.2和21.8。基线、第二次术前和第二次术后震颤临床评定量表C部分评分的平均值分别为18.4、8.2和2.6。1例患者出现轻微构音障碍和舌头不适的永久性不良事件。二次手术后无患者出现吞咽困难或认知功能障碍。5例患者中有4例对双侧治疗的结果感到满意，包括发生永久性不良事件的患者。结论：磁共振成像引导的聚焦超声是双侧丘脑切开术的一种有效方法，前提是符合以下考虑：（1）创建不对称病变;（2）手术间隔足够（>1年）。
Introduction: Essential tremor is the most common movement disorder in adults. Bilateral symptoms are typical; however, bilateral thalamotomy for essential tremor is associated with a high probability of adverse events. We retrospectively investigated the efficacy and safety of staged bilateral ventral intermediate nucleus thalamotomy for refractory essential tremor using magnetic resonance imaging-guided focused ultrasound. Methods: We enrolled 5 consecutive patients with refractory essential tremor between September 2016 and March 2020. Patients underwent a second operation at least 1 year after the first operation. The second lesion was created asymmetrically to the first lesion. Results: Mean patient age was 57.6 years, and the mean interval between the 2 operations was 27.8 months. The second lesion center was superior to the first lesion in all patients. The mean baseline, second preoperative, and second postoperative Clinical Rating Scale for Tremor total scores were 63.6, 49.2, and 21.8, respectively. The mean baseline, second preoperative, and second postoperative Clinical Rating Scale for Tremor part C scores were 18.4, 8.2, and 2.6, respectively. One patient had permanent adverse events of slight dysarthria and discomfort in the tongue. No patient experienced dysphagia or cognitive dysfunction after the second operation. Four of the 5 patients were satisfied with the results of the bilateral treatment, including the patient who had permanent adverse events. Conclusions: Magnetic resonance imaging-guided focused ultrasound is an effective method for bilateral thalamotomy when adhering to the following considerations: (1) asymmetrical lesions are created and (2) sufficient interval (>1 year) between operations.