Contarino Maria Fiorella, Van Den Munckhof Pepijn, Tijssen Marina A J, de Bie Rob M A, Bosch D Andries, Schuurman P Richard, Speelman Johannes D
Department of Neurology/Clinical Neurophysiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands,
J Neurol. 2014 Feb;261(2):300-8. doi: 10.1007/s00415-013-7188-4. Epub 2013 Nov 21.
Patients with cervical dystonia who are non-responders to Botulinum toxin qualify for surgery. Selective peripheral denervation (Bertrand's procedure, SPD) and deep brain stimulation of the globus pallidus (GPi-DBS) are available surgical options. Although peripheral denervation has potential advantages over DBS, the latter is nowadays more commonly performed. We describe the long-term outcome of selective peripheral denervation as compared with GPi-DBS, along with the findings of literature review. Twenty patients with selective peripheral denervation and 15 with GPi-DBS were included. Tsui scale, a visual analogue scale, and the global outcome score of the Toronto Western Spasmodic Torticollis Rating Scale were used to define a "combined global surgical outcome". The "combined global surgical outcome" for patients with selective peripheral denervation or pallidal stimulation was respectively "bad" for 65 and 13.3 %, "fair-to-good" for 30 and 26.7 %, and "marked" improvement for 5 and 60 % (p < 0.001). Improvement on visual analogue scale (p < 0.002), global outcome score (p < 0.002), and Tsui score (p < 0.000) was larger for the pallidal stimulation group. Seventy-five percent of patients with selective peripheral denervation and 60 % of patients with pallidal stimulation reported side effects. Seven patients with selective peripheral denervation successively underwent GPi-DBS, with a further significant improvement in the Tsui score (-48.6 ± 17.4 %). GPi-DBS is to be preferred to selective peripheral denervation for the treatment of cervical dystonia because it produces larger benefit, even if it can have more potentially severe complications. GPi-DBS is also a valid alternative in case of failure of SPD.
对肉毒杆菌毒素无反应的颈部肌张力障碍患者适合手术。选择性外周神经切断术（伯特兰手术，SPD）和苍白球内侧核深部脑刺激术（GPi-DBS）是可行的手术选择。尽管外周神经切断术比DBS有潜在优势，但如今后者更常被采用。我们描述了选择性外周神经切断术与GPi-DBS相比的长期疗效，并结合文献综述结果。纳入了20例接受选择性外周神经切断术的患者和15例接受GPi-DBS的患者。使用徐氏量表、视觉模拟量表和多伦多西部痉挛性斜颈评定量表的总体疗效评分来定义“综合总体手术疗效”。接受选择性外周神经切断术或苍白球刺激术患者的“综合总体手术疗效”分别为：“差”的比例为65%和13.3%，“中到好”的比例为30%和26.7%，“显著”改善的比例为5%和60%（p<0.001）。苍白球刺激术组在视觉模拟量表（p<0.002）、总体疗效评分（p<0.002）和徐氏评分（p<0.000）方面的改善更大。75%接受选择性外周神经切断术的患者和60%接受苍白球刺激术的患者报告有副作用。7例接受选择性外周神经切断术的患者先后接受了GPi-DBS，徐氏评分进一步显著改善（-48.6±17.4%）。对于颈部肌张力障碍的治疗，GPi-DBS比选择性外周神经切断术更可取，因为它能带来更大益处，即使可能有更多潜在严重并发症。在SPD失败的情况下，GPi-DBS也是一种有效的替代方法。
