Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,
Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Stereotact Funct Neurosurg. 2020;98(3):187-192. doi: 10.1159/000506999. Epub 2020 Apr 21.
Thalamotomy is an endorsed treatment for medication-refractory tremor. It used to be the standard, but nowadays deep brain stimulation (DBS) has become the treatment option of choice. Nevertheless, DBS has the disadvantage of hardware failure, battery replacement, and frequent setting adjustment. Radiofrequency (RF) thalamotomy lacks these issues, is relatively inexpensive, and has a broad applicability in patients with significant comorbidity. Therefore, we analyzed the long-term patient-reported outcome of RF thalamotomy in a cohort of patients with an otherwise intractable tremor.
A single-center cohort of 27 consecutive patients with intractable tremor was assessed after unilateral RF thalamotomy. Over time, 4 patients had died because of non-related causes. In total, 21 patients responded to a telephone survey to assess their personal judgment on postoperative tremor severity, using a validated tremor scale, adverse events, recurrence, and patient satisfaction. The median time between surgery and telephone survey was 39 months (range 12-126). Seven patients had an additional analysis with postoperative imaging, video-assisted electromyography tremor registration, and a self-reported treatment effect (SRTE) assessment.
Nineteen out of 21 patients (90.5%) reported absence or significant improvement of their tremor. The rating score (WHIGET/UPDRS-III) dropped significantly from a mean of 3.57 preoperatively to 1.05 postoperatively (p < 0.001). Eleven patients (52.4%) reported adverse events, but the majority (76.2%) did not consider the adverse events to be severe. SRTE assessment showed a direct postoperative effect of 89.6 of 100 points (SD 10.8), with a gradual decrease to 75.3 (SD 23.5) during follow-up.
RF thalamotomy is a very effective long-term treatment for medication-refractory tremor and should therefore be considered in patients with a refractory unilateral tremor.
丘脑切开术是一种被认可的药物难治性震颤治疗方法。它曾经是标准治疗方法，但现在深部脑刺激（DBS）已成为首选治疗方案。然而，DBS 存在硬件故障、电池更换和频繁的设置调整等缺点。射频（RF）丘脑切开术则没有这些问题，相对便宜，并且在合并症较多的患者中有广泛的适用性。因此，我们分析了一组药物难治性震颤患者接受单侧 RF 丘脑切开术后的长期患者报告结果。
对 27 例单侧 RF 丘脑切开术治疗的药物难治性震颤患者进行了单中心队列研究。随着时间的推移，有 4 例患者因非相关原因死亡。共有 21 例患者通过电话调查评估了他们对术后震颤严重程度的个人判断，使用了经过验证的震颤量表、不良事件、复发和患者满意度。手术与电话调查之间的中位时间为 39 个月（范围 12-126）。对 7 例患者进行了额外的分析，包括术后影像学、视频辅助肌电图震颤记录和自我报告的治疗效果（SRTE）评估。
21 例患者中有 19 例（90.5%）报告震颤消失或明显改善。评分（WHIGET/UPDRS-III）从术前的平均 3.57 显著降至术后的 1.05（p<0.001）。11 例患者（52.4%）报告了不良事件，但大多数（76.2%）认为不良事件不严重。SRTE 评估显示术后直接效果为 100 分中的 89.6 分（标准差 10.8），随访期间逐渐降至 75.3（标准差 23.5）。
RF 丘脑切开术是一种非常有效的药物难治性震颤长期治疗方法，因此应考虑用于单侧震颤难治的患者。
