Hirato Masafumi, Miyagishima Takaaki, Takahashi Akio, Yoshimoto Yuhei
Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
World Neurosurg. 2018 Sep;117:e349-e361. doi: 10.1016/j.wneu.2018.06.033. Epub 2018 Jun 14.
Long-term effectiveness of selective ventralis intermedius nucleus (VIM)-ventralis oralis nucleus (VO) thalamotomy with depth microrecording for the treatment of focal dystonia was evaluated. The optimal thalamic areas for controlling focal dystonia were studied based on the electrophysiologic and anatomic data.
Stereotactic selective VIM-VO thalamotomy with depth microrecording was carried out in 8 patients with focal arm and hand dystonia and in 1 patient with cervical dystonia. Electrophysiologic data on the lateral part of thalamic VIM were studied in patients with focal dystonia. A very small and narrow therapeutic lesion was formed in the shape of a square on the sagittal plane and of an I, rotated V, Y, or inverse Y on the axial plane in the VIM-VO, which covered the kinesthetic response area topographically related to focal dystonia. Patients with arm and hand dystonia were followed up for 4.7 ± 3.0 years and 1 patient with cervical dystonia was followed up for 18.2 years.
Marked improvement of focal dystonia was shown by functional assessment using the Unified Dystonia Rating Scale. Transient dysarthria was recognized in 1 patient. The sequence of body localization of kinesthetic response in the VIM was clearly shown in patients with focal dystonia. Decreases in the amplitude and amplitude ratio of electromyography on the forearm muscles were markedly significant after VIM thalamotomy, but insignificant after VO thalamotomy immediately after VIM thalamotomy.
Marked reduction of electromyographic tonic discharges of focal dystonia was shown after VIM lesioning. Selective VIM-VO thalamotomy showed good and long-term stable effects for focal dystonia.
评估采用深度微记录技术的选择性腹中间核（VIM）-腹口核（VO）丘脑切开术治疗局灶性肌张力障碍的长期疗效。基于电生理和解剖学数据研究控制局灶性肌张力障碍的最佳丘脑区域。
对8例手臂和手部局灶性肌张力障碍患者及1例颈部肌张力障碍患者实施立体定向选择性VIM-VO丘脑切开术并进行深度微记录。研究局灶性肌张力障碍患者丘脑VIM外侧部分的电生理数据。在VIM-VO中，在矢状面上形成非常小且狭窄的方形治疗性病灶，在轴面上形成I形、旋转V形、Y形或倒Y形，覆盖与局灶性肌张力障碍地形相关的本体感觉反应区域。手臂和手部肌张力障碍患者随访4.7±3.0年，1例颈部肌张力障碍患者随访18.2年。
使用统一肌张力障碍评定量表进行功能评估显示局灶性肌张力障碍有明显改善。1例患者出现短暂性构音障碍。局灶性肌张力障碍患者清楚显示了VIM中本体感觉反应的身体定位顺序。VIM丘脑切开术后前臂肌肉肌电图的幅度和幅度比明显降低，但在VIM丘脑切开术后立即进行VO丘脑切开术时不明显。
VIM毁损术后局灶性肌张力障碍的肌电图强直放电明显减少。选择性VIM-VO丘脑切开术对局灶性肌张力障碍显示出良好且长期稳定的效果。
