Rossitch E, Zeidman S M, Nashold B S, Horner J, Walker J, Osborne D, Bullard D E
Department of Surgery (Neurosurgery), Duke University School of Medicine, Durham, North Carolina 27710.
Surg Neurol. 1988 Jan;29(1):11-6. doi: 10.1016/0090-3019(88)90116-4.
Memory and language dysfunction has been sporadically reported following stereotaxic thalamotomies. In order to determine which patients are at greatest risk and to better define the nature of this dysfunction, we have prospectively evaluated 18 patients undergoing stereotaxic thalamotomies for movement disorders (MDs). Patients were evaluated clinically, with computed tomography (CT) and with memory and language protocols (MLPs) pre- and postoperatively. Patients exhibiting postoperative deficits were again evaluated with the MLP on follow-up visits to the clinic. Significant changes in memory and language function occurred in 7 out of 18 patients. These 7 patients had diverse etiologies for their MDs. Five of the 18 patients had undergone previous thalamotomies on the contralateral side. Three of these 5 patients with bilateral thalamotomies experienced postoperative functional impairments in memory and language while only 4 of 13 patients with a unilateral thalamotomy experienced these problems. The postoperative functional impairments noted were primarily those requiring orientation and speech. All patients with postoperative memory and language impairments were again evaluated with MLPs months after the operation. In 3 of 7 patients, no improvement was noted, while the remaining 4 did recover to baseline. More severe deficits tended to occur in those patients with ventriculomegaly or evidence of other major cerebral tissue loss by preoperative CT scan and in those patients with lower MLP scores preoperatively. Postoperative memory and language dysfunction was not correlated with the number or size of the lesions made, the postoperative general neurologic examination or CT scans, or the clinical response of the MDs. From our data, it appears that patients with more profound neurologic compromise and/or bilateral involvement as evidenced by poor performance on the MLP, tissue loss on CT scanning, or previous thalamic lesion, are most at risk for memory and language dysfunction postoperatively. However, this dysfunction is not necessarily permanent. Preoperative evaluation with MLPs and CT scanning appear to be of value in predicting those patients at greatest risk for postoperative and language dysfunction.
立体定向丘脑切开术后偶尔会有记忆和语言功能障碍的报道。为了确定哪些患者风险最大，并更好地界定这种功能障碍的性质，我们前瞻性地评估了18例因运动障碍（MD）接受立体定向丘脑切开术的患者。术前和术后对患者进行了临床评估、计算机断层扫描（CT）以及记忆和语言方案（MLP）评估。术后出现缺陷的患者在门诊随访时再次接受MLP评估。18例患者中有7例出现了记忆和语言功能的显著变化。这7例患者的MD病因各不相同。18例患者中有5例曾在对侧接受过丘脑切开术。这5例双侧丘脑切开术患者中有3例术后出现记忆和语言功能障碍，而13例单侧丘脑切开术患者中只有4例出现这些问题。术后观察到的功能障碍主要是那些需要定向和言语方面的问题。所有术后有记忆和语言障碍的患者在术后数月再次接受MLP评估。7例患者中有3例未见改善，其余4例恢复到了基线水平。术前CT扫描显示脑室扩大或有其他主要脑组织丢失迹象的患者以及术前MLP评分较低的患者往往会出现更严重的缺陷。术后记忆和语言功能障碍与所造病变的数量或大小、术后一般神经学检查或CT扫描以及MD的临床反应均无关联。根据我们的数据，似乎MLP表现不佳、CT扫描显示组织丢失或既往有丘脑病变所证明的神经功能损害更严重和/或双侧受累的患者术后发生记忆和语言功能障碍的风险最高。然而，这种功能障碍不一定是永久性的。术前用MLP和CT扫描进行评估似乎有助于预测哪些患者术后发生记忆和语言功能障碍的风险最大。
