Department of Neurosurgery, Xuanwu Hospital, Capital Medical University , Beijing, China.
Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University , Beijing, China.
Expert Rev Med Devices. 2020 Aug;17(8):817-833. doi: 10.1080/17434440.2020.1806709.
Surgical treatments are considered for essential tremor (ET) when patients do not respond to oral pharmacological therapies. These treatments mainly comprise radiofrequency (RF) thalamotomy, gamma knife radiosurgery (GKRS), deep brain stimulation (DBS), and focused ultrasound (FUS) procedures.
We reviewed the strengths and weaknesses of each procedure and clinical outcomes for 7 RF studies (n = 85), 11 GKRS (n = 477), 33 DBS (n = 1061), and 13 FUS studies (n = 368). A formal comparison was not possible given the heterogeneity in studies. Improvements were about 42%-90% RF, 10%-79% GKRS, 45%-83% DBS, 42%-83% FUS at short-term follow-up (<12 months) and were about 54%-82% RF, 11%-84% GKRS, 18%-92% DBS, and 42%-80% FUS at long-term follow-up (>12 months).
We found DBS with inherent advantages of being an adjustable and reversible procedure as the most frequently employed surgical procedure for control of ET symptoms. FUS is a promising procedure but has limited applicability for unilateral control of symptoms. RF is invasive, and GKRS has unpredictable delayed effects. Each of these surgical modalities has advantages and limitations that need consideration when selecting a treatment for the ET patients.
当患者对口服药物治疗无反应时，手术治疗被认为是治疗原发性震颤（ET）的方法。这些治疗方法主要包括射频（RF）丘脑切开术、伽玛刀放射外科手术（GKRS）、深部脑刺激（DBS）和聚焦超声（FUS）手术。
我们回顾了每种手术的优缺点，以及 7 项 RF 研究（n=85）、11 项 GKRS 研究（n=477）、33 项 DBS 研究（n=1061）和 13 项 FUS 研究（n=368）的临床结果。由于研究之间存在异质性，因此无法进行正式比较。在短期随访（<12 个月）时，RF 的改善约为 42%-90%，GKRS 的改善约为 10%-79%，DBS 的改善约为 45%-83%，FUS 的改善约为 42%-83%；在长期随访（>12 个月）时，RF 的改善约为 54%-82%，GKRS 的改善约为 11%-84%，DBS 的改善约为 18%-92%，FUS 的改善约为 42%-80%。
我们发现 DBS 作为一种可调节和可逆的手术，具有固有优势，是控制 ET 症状的最常用手术方法。FUS 是一种很有前途的手术方法，但仅适用于单侧症状的控制。RF 是一种侵入性手术，GKRS 具有不可预测的延迟效果。在为 ET 患者选择治疗方法时，需要考虑到每种手术方法的优缺点和局限性。
