Stereotactic Ventrooralis Thalamotomy for Task-Specific Focal Hand Dystonia (Writer’s Cramp)
Stereotactic Ventrooralis Thalamotomy for Task-Specific Focal Hand Dystonia (Writer’s Cramp)
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立体定向丘脑腹腔切除术治疗任务特异性局灶性手肌张力障碍（作家痉挛）
DOI：
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发表时间：
2004
影响因子：
1.7
通讯作者：
T. Hori
中科院分区：
文献类型：
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作者：
T. Taira;T. Hori
背景：书写痉挛是一种由于苍白球-丘脑-皮质回路功能障碍引起的局灶性肌张力障碍。大多数保守治疗难以治愈，但肉毒杆菌毒素注射通常用于缓解症状。作为一种肌张力障碍的手术治疗，我们进行了立体定向丘脑腹侧核（Vo）的肌张力障碍性痉挛的手。研究方法：12例（5例男性，3例女性;年龄26-40岁，平均32.1岁）患有难治性手部任务特异性局灶性肌张力障碍的患者接受了Vo丘脑切开术。立体定向靶点选择在Vo核前后交界处。结果：症状持续时间3 ~ 6年，平均4.5年。所有患者都抱怨书写困难。7名患者是专业人员，如漫画家、吉他手和理发师，由于在工作期间出现肌张力障碍症状，他们已停止从事自己的职业。所有患者术后肌张力障碍症状立即消失，随访3-33个月，平均13.1个月，除1例外，效果持续。两名病人的症状部分复发，并接受了第二次丘脑切开术后5个月的首次手术满意的结果。写痉挛量表评分在Vo丘脑切开术后显著降低（p < 0.001）。无永久性手术并发症。无死亡或永久性发病。结论：虽然需要较长的随访时间，但立体定向丘脑VO毁损术是一种有效且安全的治疗书写痉挛的方法。
Background: Writer’s cramp is a type of focal dystonia due to dysfunction of the pallido-thalamo-cortical circuit. The symptom is refractory to most conservative treatment, though botulinum toxin injection is generally used for symptomatic relief. As a surgical treatment of dystonia, we performed stereotactic nucleus ventrooralis (Vo) thalamotomy for dystonic cramp of the hand. Methods: Twelve patients (5 men, 3 women; age 26–40 years, mean 32.1 years) with medically intractable task-specific focal dystonia of the hand underwent Vo thalamotomy. The stereotactic target was chosen at the junction of the anterior and posterior Vo nuclei. Results: The mean duration of the symptom ranged from 3 to 6 years (mean 4.5 years.) All patients had complained of difficulty in writing. Seven patients were professionals, such as a comic artist, guitarist and barber, and, because of the dystonic symptoms occurring during their work, they had stopped pursuing their profession. All patients showed immediate postoperative disappearance of dystonic symptoms, and the effect was sustained during the follow-up period (3–33 months, mean 13.1 months), except in one case. Two patients showed partial recurrence of the symptom and underwent second thalamotomy 5 months after the initial surgery with satisfactory results. The score on the writer’s cramp rating scale decreased significantly (p < 0.001) after Vo thalamotomy. There were no permanent operative complications. There was no mortality or permanent morbidity. Conclusion: Although a longer follow-up is needed, stereotactic Vo thalamotomy is a useful and safe therapeutic option for writer’s cramp.