Taira Takaomi, Hori Tomokatsu
Department of Neurosurgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan.
Brain Nerve. 2008 Dec;60(12):1427-36.
Although non-destructive neuromodulation is becoming popular, ablative neurosurgical procedures still play a very important role in the management of harmful spasticity. There are 2 major ablative surgeries for spasticity control. One is selective peripheral neurotomy that is indicated for focal spasticity such as equinus foot and inversion of the foot. Other indications are sciatic neurotomy for knee flexion spasticity, musculocutaneous neurotomy for elbow flexion spasticity, median nerve neurotomy for finger flexion spasticity and so on. The operative invasiveness of such procedures is small with several extraordinary advantage. Another well-established method is selective dorsal rhizotomy that is indicated for diffuse paraplegic spasticity in cerebral palsy children. Recent reports on randomized-controlled studies indicate its long-term effectiveness. A less invasive technique and intraoperative neurophysiologic assessment is important in selective dorsal rhizotomy to maximize clinical benefits and minimize complications. Surgical management of harmful spasticity is a very important and rewarding clinical practice, and should be one of the standards employed in clinical neurosurgical practice.
尽管非破坏性神经调节正变得越来越流行，但消融性神经外科手术在有害痉挛的治疗中仍发挥着非常重要的作用。有两种主要的用于控制痉挛的消融手术。一种是选择性周围神经切断术，适用于诸如马蹄足和足内翻等局部痉挛。其他适应症包括用于膝关节屈曲痉挛的坐骨神经切断术、用于肘关节屈曲痉挛的肌皮神经切断术、用于手指屈曲痉挛的正中神经切断术等。此类手术的手术侵袭性较小，有几个显著优点。另一种成熟的方法是选择性背根切断术，适用于脑瘫患儿的弥漫性截瘫痉挛。近期关于随机对照研究的报告表明了其长期有效性。在选择性背根切断术中，一种侵入性较小的技术和术中神经生理学评估对于最大化临床益处和最小化并发症很重要。有害痉挛的外科治疗是一项非常重要且有意义的临床实践，应该成为临床神经外科实践中采用的标准之一。
