Takeda Nobuhiko, Horisawa Shiro, Taira Takaomi, Kawamata Takakazu
Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
World Neurosurg. 2018 Jul;115:220-224. doi: 10.1016/j.wneu.2018.04.055. Epub 2018 Apr 19.
Deep brain stimulation (DBS) is an established treatment for generalized dystonia. However, the DBS device is sometimes removed owing to hardware complications. We present 4 cases of generalized dystonia treated with radiofrequency lesioning through DBS electrodes.
Four patients, 3 men and 1 woman (age range, 34-44 years), underwent DBS for generalized dystonia and subsequently developed complications, such as infection, necessitating removal of the devices. As stopping the stimulation caused recurrence of uncontrollable symptoms, radiofrequency lesioning was performed through the DBS electrodes under local anesthesia, and the DBS systems were removed under local or generalized anesthesia thereafter. The procedures performed were as follows: 2 patients had bilateral pallidotomy, 1 patient had unilateral pallidotomy, and 1 patient had pallidotomy and ipsilateral thalamotomy. As a result, in 4 patients, the dystonic symptoms did not worsen even after removal of the DBS systems during a follow-up period of 1-12 years. However, 1 patient had a small hemorrhage, and 2 patients showed recurrence of dystonia.
Radiofrequency lesioning with DBS electrodes is feasible in cases of generalized dystonia when the DBS leads have to be removed.
脑深部电刺激术（DBS）是一种已确立的治疗全身性肌张力障碍的方法。然而，DBS设备有时会因硬件并发症而被移除。我们报告4例通过DBS电极进行射频毁损治疗全身性肌张力障碍的病例。
4例患者，3男1女（年龄范围34 - 44岁），因全身性肌张力障碍接受DBS治疗，随后出现感染等并发症，需要移除设备。由于停止刺激会导致无法控制的症状复发，在局部麻醉下通过DBS电极进行射频毁损，随后在局部或全身麻醉下移除DBS系统。所进行的手术如下：2例患者进行双侧苍白球切开术，1例患者进行单侧苍白球切开术，1例患者进行苍白球切开术和同侧丘脑切开术。结果，4例患者在1至12年的随访期内，即使在移除DBS系统后，肌张力障碍症状也未恶化。然而，1例患者出现小出血，2例患者出现肌张力障碍复发。
当必须移除DBS电极时，在全身性肌张力障碍病例中，使用DBS电极进行射频毁损是可行的。
