Incisionless transcranial MR-guided focused ultrasound in essential tremor: cerebellothalamic tractotomy.
Incisionless transcranial MR-guided focused ultrasound in essential tremor: cerebellothalamic tractotomy.
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DOI：
10.1186/s40349-016-0049-8
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Jeanmonod D
中科院分区：
文献类型：
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作者：
Gallay MN;Moser D;Rossi F;Pourtehrani P;Magara AE;Kowalski M;Arnold A;Jeanmonod D
早在 20 世纪 60 年代末和 70 年代初，不同的功能神经外科小组就探索了以“后丘脑区 (PSA)”为目标，应用射频 (RF) 技术来治疗特发性震颤 (ET) 患者。磁共振 (MR) 引导聚焦超声 (MRgFUS) 技术的最新进展提供了在不穿透大脑的情况下对 PSA 中的小脑丘脑纤维束进行热凝的可能性，从而大大降低了手术相关风险并提高了准确性。我们在这里描述 MRgFUS 小脑丘脑束切开术 (CTT) 的第一个结果。连续 21 名患有慢性（平均病程 29.9 年）、难治性 ET 的患者接受了 MRgFUS CTT 治疗。 3名患者接受双侧治疗，间隔1年。主要缓解评估指标是随访（3 个月至 2 年）时采用的特发性震颤评定量表（Fahn、Tolosa 和 Marin）(ETRS)，重点关注手部功能分项评分（接受治疗的手为 HF16，双手为 HF32）和笔迹。 7 名 HF32 超过 32 分超过 28 分的患者（第 1 组）的演变与其他患者（第 2 组）不同，并进行了单独分析。患者提供了全身震颤缓解的估计。对每个 CTT 病灶治疗后 2 天的 MR 图片进行病灶重建和靶向精度测量。所有患者的平均 ETRS 评分在基线时为 57.6±13.2，在 1 年时为 25.8±17.6 (n=10)。第 2 组的 HF16 分数在 3 个月时下降了 92%，并在 1 年时保持稳定 (90%)。第 1 组在 3 个月时仅改善了 41%，在 1 年时仅改善了 40%。尽管如此，第 1 组中的两名患者在接受双侧治疗 1 年后，惯用手的 HF16 评分分别降低了 75% 和 88%。 CTT 后患者对全身震颤缓解的平均估计在 2 天时为 92%，在 1 年随访时为 77%。对于难治性原发性震颤患者来说，CTT 联合 MRgFUS 被证明是一种有效且安全的方法，它将神经功能保留与精确靶向以及双侧治疗患者的可能性结合起来。
Already in the late 1960s and early 1970s, targeting of the “posterior subthalamic area (PSA)” was explored by different functional neurosurgical groups applying the radiofrequency (RF) technique to treat patients suffering from essential tremor (ET). Recent advances in magnetic resonance (MR)-guided focused ultrasound (MRgFUS) technology offer the possibility to perform thermocoagulation of the cerebellothalamic fiber tract in the PSA without brain penetration, allowing a strong reduction of the procedure-related risks and increased accuracy. We describe here the first results of the MRgFUS cerebellothalamic tractotomy (CTT). Twenty-one consecutive patients suffering from chronic (mean disease duration 29.9 years), therapy-resistant ET were treated with MRgFUS CTT. Three patients received bilateral treatment with a 1-year interval. Primary relief assessment indicators were the Essential Tremor Rating Scale (Fahn, Tolosa, and Marin) (ETRS) taken at follow-up (3 months to 2 years) with accent on the hand function subscores (HF16 for treated hand and HF32 for both hands) and handwriting. The evolution of seven patients with HF32 above 28 points over 32 (group 1) differentiated itself from the others’ (group 2) and was analyzed separately. Global tremor relief estimations were provided by the patients. Lesion reconstruction and measurement of targeting accuracy were done on 2-day post-treatment MR pictures for each CTT lesion. The mean ETRS score for all patients was 57.6 ± 13.2 at baseline and 25.8 ± 17.6 at 1 year (n = 10). The HF16 score reduction was 92 % in group 2 at 3 months and stayed stable at 1 year (90 %). Group 1 showed only an improvement of 41 % at 3 months and 40 % at 1 year. Nevertheless, two patients of group 1 treated bilaterally had an HF16 score reduction of 75 and 88 % for the dominant hand at 1 year after the second side. The mean patient estimation of global tremor relief after CTT was 92 % at 2 days and 77 % at 1-year follow-up. CTT with MRgFUS was shown to be an effective and safe approach for patients with therapy-refractory essential tremor, combining neurological function sparing with precise targeting and the possibility to treat patients bilaterally.