Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Kanazawa, Ishikawa, Japan.
Department of Neurosurgery, Tokyo Women's Hospital, Tokyo, Japan.
World Neurosurg. 2019 Jul;127:8-10. doi: 10.1016/j.wneu.2019.03.199. Epub 2019 Mar 28.
Stereotactic ventro-oral thalamotomy has been performed in cases of focal task-specific dystonia, including writer's cramp, with excellent outcomes. However, no reports have revealed the outcome of ventro-oral thalamotomy in a patient with a contralateral cerebral lesion. We describe a patient with left-hand writer's cramp with an old lesion in the left hemisphere and transient gait disturbance after right ventro-oral thalamotomy.
A 43-year-old man had a hemorrhage in the left basal ganglia due to cerebral arteriovenous malformation at 22 years of age, and right hemiparesis remained as a sequela. He developed left-handed writing ability; however, he became aware of the stiffness of his left hand and difficulty in writing. Writer's cramp was diagnosed. Medical treatments were not effective, and right ventro-oral thalamotomy was performed. Although his writing ability improved, he could not walk. After performing rehabilitation, his walking completely improved, reaching the level before surgery, after 3 months, and his writer's cramp was completely cured.
In patients with basal nucleus lesions, gait disturbance may appear transiently after contralateral thalamotomy. It is crucial to fully explain the potential complications, particularly in relation to temporal gait disturbances, and obtain informed consent.
立体定向腹侧口腔丘脑切开术已应用于局灶性任务特异性肌张力障碍的病例中，包括书写痉挛，效果极佳。然而，尚无报告显示腹侧口腔丘脑切开术在伴有对侧大脑病变的患者中的效果。我们描述了一位左手书写痉挛患者，其左侧大脑半球有陈旧性病变，在接受右侧腹侧口腔丘脑切开术后出现一过性步态障碍。
一名 43 岁男性在 22 岁时因脑动静脉畸形导致基底节出血，留有右侧偏瘫后遗症。他出现了用左手书写的能力，但他开始感到左手僵硬，书写困难。诊断为书写痉挛。经药物治疗无效，遂行右侧腹侧口腔丘脑切开术。虽然他的书写能力有所改善，但他无法行走。经过康复治疗，他的行走能力在 3 个月后完全恢复到术前水平，并且他的书写痉挛完全治愈。
对于基底核病变的患者，在对侧丘脑切开术后可能会出现一过性步态障碍。充分解释潜在并发症至关重要，特别是与短暂性步态障碍相关的并发症，需要获得患者的知情同意。
