Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
J Neurol Neurosurg Psychiatry. 2019 Apr;90(4):474-482. doi: 10.1136/jnnp-2018-318240. Epub 2018 Oct 18.
There are several different surgical procedures that are used to treat essential tremor (ET), including deep brain stimulation (DBS) and thalamotomy procedures with radiofrequency (RF), radiosurgery (RS) and most recently, focused ultrasound (FUS). Choosing a surgical treatment requires a careful presentation and discussion of the benefits and drawbacks of each. We conducted a literature review to compare the attributes and make an appraisal of these various procedures. DBS was the most commonly reported treatment for ET. One-year tremor reductions ranged from 53% to 63% with unilateral Vim DBS. Similar improvements were demonstrated with RF (range, 74%-90%), RS (range, 48%-63%) and FUS thalamotomy (range, 35%-75%). Overall, bilateral Vim DBS demonstrated more improvement in tremor reduction since both upper extremities were treated (range, 66%-78%). Several studies show continued beneficial effects from DBS up to five years. Long-term follow-up data also support RF and gamma knife radiosurgical thalamotomy treatments. Quality of life measures were similarly improved among patients who received all treatments. Paraesthesias, dysarthria and ataxia were commonly reported adverse effects in all treatment modalities and were more common with bilateral DBS surgery. Many of the neurological complications were transient and resolved after surgery. DBS surgery had the added benefit of programming adjustments to minimise stimulation-related complications. Permanent neurological complications were most commonly reported for RF thalamotomy. Thalamic DBS is an effective, safe treatment with a long history. For patients who are medically unfit or reluctant to undergo DBS, several thalamic lesioning methods have parallel benefits to unilateral DBS surgery. Each of these surgical modalities has its own nuance for treatment and patient selection. These factors should be carefully considered by both neurosurgeons and patients when selecting an appropriate treatment for ET.
有几种不同的手术程序可用于治疗原发性震颤（ET），包括深部脑刺激（DBS）和丘脑切开术，可采用射频（RF）、放射外科（RS）以及最近的聚焦超声（FUS）。选择手术治疗需要仔细介绍和讨论每种治疗方法的优缺点。我们进行了文献回顾，以比较这些不同程序的属性并进行评估。DBS 是最常报告用于 ET 的治疗方法。单侧 Vim DBS 的一年震颤缓解率为 53%至 63%。类似的改善也在 RF（范围为 74%-90%）、RS（范围为 48%-63%）和 FUS 丘脑切开术（范围为 35%-75%）中得到证明。总体而言，双侧 Vim DBS 由于双侧上肢都得到治疗，震颤缓解的改善程度更大（范围为 66%-78%）。几项研究表明，DBS 的持续有益效果可达五年。长期随访数据也支持 RF 和伽玛刀放射外科丘脑切开术的治疗。接受所有治疗的患者的生活质量衡量标准也得到了类似的改善。所有治疗方式中都常见感觉异常、构音障碍和共济失调等不良反应，双侧 DBS 手术更为常见。许多神经并发症是短暂的，并在手术后得到解决。DBS 手术具有额外的编程调整好处，可最大程度地减少刺激相关并发症。RF 丘脑切开术最常报告永久性神经并发症。丘脑 DBS 是一种有效且安全的治疗方法，具有悠久的历史。对于不适合接受药物治疗或不愿意接受 DBS 的患者，几种丘脑损伤方法与单侧 DBS 手术具有相似的益处。这些手术方式中的每一种都有其自身的治疗和患者选择细微差别。神经外科医生和患者在为 ET 选择适当的治疗方法时应仔细考虑这些因素。
