Niranjan A, Jawahar A, Kondziolka D, Lunsford L D
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Stereotact Funct Neurosurg. 1999;72(2-4):178-84. doi: 10.1159/000029723.
Between April 1994 and January 1999, 39 stereotactic procedures for patients with intractable tremor were performed at the University of Pittsburgh Medical Center. A retrospective analysis of results of radiosurgical thalamotomy (n = 15), MR-guided stereotactic radiofrequency thalamotomy (n = 13), and deep brain thalamic stimulation (DBS; n = 11) was performed to study relative advantages and risks of these procedures.
All options were discussed with the patients, but radiosurgery usually was performed in elderly patients with concurrent medical problems. Stereotactic thalamotomy and DBS was performed with MR guidance and macrostimulation. For radiosurgery, a median dose of 140 Gy (range 130-150 Gy) was delivered using a single 4-mm collimator.
Of the 13 patients who underwent radiofrequency thalamotomy, 5 had immediate complete arrest of tremor, 6 had a significant reduction and 2 had partial reduction. All 11 patients who underwent DBS had excellent control of tremor immediately after the procedure, and in longer-term follow-up 10/11 maintained excellent tremor control. Of the 12 evaluable radiosurgery patients, 10 noted excellent relief and 2 had partial relief.
Stereotactic procedures for tremor control are safe and effective. Each procedure has specific advantages and disadvantages that are important for patient selection.
1994年4月至1999年1月期间，匹兹堡大学医学中心对39例顽固性震颤患者实施了立体定向手术。对放射外科丘脑切开术（n = 15）、磁共振引导立体定向射频丘脑切开术（n = 13）和脑深部丘脑刺激术（DBS；n = 11）的结果进行回顾性分析，以研究这些手术的相对优势和风险。
所有手术方案都与患者进行了讨论，但放射外科手术通常用于患有并存疾病的老年患者。立体定向丘脑切开术和DBS在磁共振引导和宏观刺激下进行。对于放射外科手术，使用单个4毫米准直器给予的中位剂量为140 Gy（范围130 - 150 Gy）。
在接受射频丘脑切开术的13例患者中，5例震颤立即完全停止，6例显著减轻，2例部分减轻。接受DBS的所有11例患者术后震颤立即得到良好控制，在长期随访中，11例中有10例维持了良好的震颤控制。在12例可评估的放射外科手术患者中，10例表示震颤得到极好缓解，2例部分缓解。
立体定向手术控制震颤安全有效。每种手术都有特定的优缺点，这对患者选择很重要。
