De Ridder Dirk, Joos Kathleen, Vanneste Sven
Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, New Zealand;
Department of Neurosurgery, University Hospital Antwerp, Belgium; and.
J Neurosurg. 2016 Apr;124(4):893-901. doi: 10.3171/2015.3.JNS142880. Epub 2015 Aug 28.
Tinnitus can be distressful, and tinnitus distress has been linked to increased beta oscillatory activity in the dorsal anterior cingulate cortex (dACC). The amount of distress is linked to alpha activity in the medial temporal lobe (amygdala and parahippocampal area), as well as the subgenual (sg)ACC and insula, and the functional connectivity between the parahippocampal area and the sgACC at 10 and 11.5 Hz. The authors describe 2 patients with very severely distressing intractable tinnitus who underwent transcranial magnetic stimulation (TMS) with a double-cone coil targeting the dACC and subsequent implantation of electrodes on the dACC. One of the patients responded to the implant and one did not, even though phenomenologically they both expressed the same tinnitus loudness and distress. The responder has remained dramatically improved for more than 2 years with 6-Hz burst stimulation of the dACC. The 2 patients differed in functional connectivity between the area of the implant and a tinnitus network consisting of the parahippocampal area as well as the sgACC and insula; that is, the responder had increased functional connectivity between these areas, whereas the nonresponder had decreased functional connectivity between these areas. Only the patient with increased functional connectivity linked to the target area of repetitive TMS or implantation might transmit the stimulation current to the entire tinnitus network and thus clinically improve.
耳鸣可能令人痛苦，而耳鸣痛苦与背侧前扣带回皮质（dACC）中β振荡活动增加有关。痛苦程度与内侧颞叶（杏仁核和海马旁区域）、膝下（sg）ACC和脑岛中的α活动，以及海马旁区域与sgACC在10赫兹和11.5赫兹时的功能连接有关。作者描述了2例患有极其严重痛苦且难以治疗的耳鸣患者，他们接受了针对dACC的双锥线圈经颅磁刺激（TMS），随后在dACC上植入电极。其中1例患者对植入有反应，另1例则没有，尽管从现象学上看他们都表现出相同的耳鸣响度和痛苦程度。有反应的患者在对dACC进行6赫兹爆发刺激后，病情显著改善超过2年。这2例患者在植入区域与由海马旁区域以及sgACC和脑岛组成的耳鸣网络之间的功能连接存在差异；也就是说，有反应的患者在这些区域之间的功能连接增加，而无反应的患者在这些区域之间的功能连接减少。只有与重复TMS或植入的目标区域相关的功能连接增加的患者，才可能将刺激电流传输到整个耳鸣网络，从而在临床上得到改善。
