Department of Neurosurgery, Pr Rousseaux CHU Maison Blanche, 45 Rue Cognacq Jay, Reims, France.
Brain Stimul. 2009 Jul;2(3):132-7. doi: 10.1016/j.brs.2008.11.001. Epub 2009 Feb 28.
Tinnitus is a public health issue in France. Around 1% of the population is affected and 30,000 people are handicapped in their daily life. The treatments available for disabling tinnitus have until now been disappointing. We are reporting on the surgical treatment by electrical stimulation of the auditory cortex of a female patient affected by disabling tinnitus that resisted classical treatments. The tinnitus appeared suddenly 10 years ago after a left ear tympanoplasty. The acouphenometry measures revealed a bilateral tinnitus, predominant on the right side, constant, with high frequency (6000 Hz). Transcranial magnetic stimulation (TMS) was performed at first with several supraliminal and infraliminal protocols. This showed promising results. Anatomic and functional magnetic resonance imaging (fMRI) of the auditory cortex before and after repetitive TMS (rTMS) demonstrated a modification of the cortical activity and where the ideal location for a cortical electrode might be, to straddle primary and secondary auditory cortex. After these investigations, two quadra polar electrodes (Resume, Medtronic Ltd, Hertfordshire, UK), connected to a stimulating device implanted under the skin (Synergy, Medtronic Ltd), were extradurally implanted. The surgical procedure was similar to the one performed for analgesic cortical stimulation. No surgical complications were reported. The activation of the stimulator provided a reduction of 65% of the tinnitus impact, with a persistent effect on the right side. The feasibility of the cortical stimulation in symptomatic treatment of tinnitus was proven by this preparatory work. The middle- and long-term therapeutic effects remain to be evaluated.
耳鸣是法国的一个公共卫生问题。大约有 1%的人口受到影响，3 万人在日常生活中受到影响。目前，对于致残性耳鸣的治疗效果一直令人失望。我们报告了一位女性患者因致残性耳鸣接受听觉皮层电刺激手术治疗的情况。该患者的耳鸣是在 10 年前左耳鼓室成形术后突然出现的。耳鸣计测量显示双侧耳鸣，右侧为主，持续存在，频率较高（6000Hz）。首先进行了经颅磁刺激（TMS），采用了几种阈上和阈下方案。结果显示有一定效果。重复经颅磁刺激（rTMS）前后对听觉皮层进行解剖和功能磁共振成像（fMRI）显示，皮层活动发生了改变，理想的皮层电极位置可能跨越初级和次级听觉皮层。在这些研究之后，两个四极电极（Resume，Medtronic Ltd，Hertfordshire，UK），连接到植入皮下的刺激装置（Synergy，Medtronic Ltd），被硬膜外植入。手术过程与镇痛皮层刺激的手术过程相似。没有手术并发症报告。刺激器的激活使耳鸣的影响降低了 65%，右侧的效果持续存在。通过这项预备性工作，证明了皮层刺激在耳鸣症状治疗中的可行性。中、长期治疗效果仍有待评估。
