Bilateral Radiofrequency Ventral Intermediate Thalamotomy for Essential Tremor
Bilateral Radiofrequency Ventral Intermediate Thalamotomy for Essential Tremor
复制标题
双侧射频腹侧中间丘脑切除术治疗特发性震颤
DOI：
10.1159/000528825
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发表时间：
2023
影响因子：
1.7
通讯作者：
Takaomi Taira 1
中科院分区：
文献类型：
--
作者：
Shiro Horisawa 1;Taku Nonaka 1;Kotaro Kohara 1;Tatsuki Mochizuki 1;Takakazu Kawamata 1;Takaomi Taira 1
引言：随着MR引导聚焦超声的出现，双侧腹侧中间（Vim）丘脑切开术治疗特发性震颤（ET）的有效性和安全性的重要性增加。然而，关于双侧Vim丘脑切开术治疗ET.Methods：回顾性分析双侧Vim丘脑切开术治疗上肢ET的结果和并发症，我们回顾性分析了接受双侧Vim丘脑切开术联合射频（RF）热凝固的ET患者。由于双侧同时丘脑切开术可引起手术并发症，因此分阶段进行丘脑切开术。第一次和第二次丘脑切开术之间的间隔为21.3 ± 14.7个月。分别在第一次和第二次治疗前后使用震颤临床评定量表（CRST）评价疗效。我们还评估了第一次和第二次治疗前后的并发症。结果：17例患者纳入研究。第二次丘脑切开术后的平均随访期为29.3 ± 15.0个月。CRST A + B部分评分分别为34.9 ± 9.7、20.8 ± 7.0和7.4 ± 6.8，第一次（改善40.4%，p< 0.0001）和第二次丘脑切开术（改善78.6%，p< 0.0001）后。9名患者出现长期不良事件，包括构音障碍、味觉障碍、吞咽困难、舌麻木、步态不稳和最后一次评估时的姿势不稳。所有不良事件均为轻度，并没有干扰患者的日常activity.Discussion/Conclusions：双侧Vim丘脑切开术与RF热凝固是一种有效的治疗ET在两个上肢。尽管大多数可能的并发症是轻微的，但需要更大样本量的额外研究来确保患者安全。
Introduction:With the advent of MR-guided focused ultrasound, the importance of the efficacy and safety of bilateral ventral intermediate (Vim) thalamotomy for essential tremor (ET) has increased. However, reports on bilateral Vim thalamotomy for ET remain scarce.Methods:To review the results and complications of bilateral Vim thalamotomy for the treatment of ET in the upper extremities, we retrospectively analyzed the patients with ET who underwent bilateral Vim thalamotomy with radiofrequency (RF) thermal coagulation. As bilateral simultaneous thalamotomy can cause surgical complications, thalamotomy was performed in stages. The interval between the first and second thalamotomies was 21.3 ± 14.7 months. We evaluated the efficacy using the Clinical Rating Scale for Tremor (CRST) before and after the first and second treatments, respectively. We also evaluated the complications before and after the first and second treatments, respectively. Moreover, we assessed the adverse events.Results:Seventeen patients were included in the study. The mean follow-up period following the second thalamotomy was 29.3 ± 15.0 months. The CRST part A + B scores were 34.9 ± 9.7, 20.8 ± 7.0, and 7.4 ± 6.8 before, following the first (40.4% improvement,p< 0.0001) and second thalamotomies (78.6% improvement,p< 0.0001), respectively. Nine patients presented with prolonged adverse events, including dysarthria, dysgeusia, dysphagia, tongue numbness, unsteady gait, and postural instability at the last available evaluation. All adverse events were mild and did not interfere with the patient’s daily activities.Discussion/Conclusions:Bilateral Vim thalamotomy with RF thermal coagulation was an effective treatment for ET in both upper extremities. Despite most possible complications being mild, additional studies with a larger sample size are required to ensure patient safety.
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