Novak Kevin E, Nenonene Emmanuel K, Bernstein Lawrence P, Vergenz Sandra, Cozzens Jeffrey W, Rezak Michael
Department of Neurology, Evanston Northwestern Healthcare, Evanston, IL 60201, USA.
Stereotact Funct Neurosurg. 2008;86(2):80-6. doi: 10.1159/000112428. Epub 2007 Dec 12.
Several subcortical structures have been targeted for surgical treatment of dystonia, including motor thalamus, internal segment of globus pallidus (GPi), and more recently, the subthalamic nucleus (STN). Deep brain stimulation of GPi is currently the preferred surgical treatment, but it is unclear if targeting other structures would yield better results. Patients who have already had a pallidotomy yet continue to experience dystonic symptoms may be limited in further treatment options.
A patient with medically intractable, segmental, early-onset, primary torsion dystonia presented for surgical consultation after exhausting nearly all treatment options. Medications, botulinum toxin injections, cervical denervation surgery, and left-sided pallidotomy failed to give adequate relief. The patient was implanted with STN stimulating leads bilaterally according to standard procedures.
The patient received a 36% improvement in dystonic symptoms as measured by several dystonia rating scales. These benefits persisted for 2 years after surgery despite several hardware-related complications, and the patient reported being very satisfied with the outcome.
This result supports the efficacy of STN deep brain stimulation in dystonia patients, even those with prior pallidotomy.
几个皮质下结构已成为肌张力障碍手术治疗的靶点，包括运动丘脑、苍白球内侧部（GPi），以及最近的丘脑底核（STN）。目前，苍白球内侧部的深部脑刺激是首选的手术治疗方法，但尚不清楚针对其他结构是否会产生更好的效果。已经接受过苍白球切开术但仍有肌张力障碍症状的患者，其进一步的治疗选择可能会受到限制。
一名患有药物难治性、节段性、早发性、原发性扭转性肌张力障碍的患者，在几乎用尽所有治疗方法后前来进行手术咨询。药物治疗、肉毒杆菌毒素注射、颈部去神经手术和左侧苍白球切开术均未能提供充分缓解。根据标准程序，为该患者双侧植入了丘脑底核刺激电极。
通过几个肌张力障碍评定量表测量，患者的肌张力障碍症状改善了36%。尽管出现了一些与硬件相关的并发症，但这些益处术后持续了2年，患者报告对结果非常满意。
这一结果支持了丘脑底核深部脑刺激对肌张力障碍患者的疗效，即使是那些先前接受过苍白球切开术的患者。
