Gadot Ron, Shofty Ben, Najera Ricardo A, Anand Adrish, Banks Garrett, Khan Abdul Basit, LoPresti Melissa A, Vanegas Arroyave Nora, Sheth Sameer A
Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States.
Department of Neurological Surgery, Columbia University Medical Center, New York, NY, United States.
Front Neurosci. 2021 Nov 8;15:774073. doi: 10.3389/fnins.2021.774073. eCollection 2021.
Movement disorders can be common, persistent, and debilitating sequelae of severe traumatic brain injury. Post-traumatic movement disorders are usually complex in nature, involving multiple phenomenological manifestations, and can be difficult to control with medical management alone. Deep brain stimulation (DBS) has been used to treat these challenging cases, but distorted brain anatomy secondary to trauma can complicate effective targeting. In such cases, use of diffusion tractography imaging and inpatient testing with externalized DBS leads can be beneficial in optimizing outcomes. We present the case of a 42-year-old man with severe, disabling post-traumatic tremor who underwent bilateral, dual target DBS to the globus pallidus internus (GPi) and a combined ventral intermediate nucleus of the thalamus (Vim)/dentato-rubro-thalamic tracts (DRTT) target. DRTT fiber tracts were reconstructed preoperatively to assist in surgical targeting given the patient's distorted anatomy. Externalization and survey of the four leads extra-operatively with inpatient testing allowed for internalization of the leads that demonstrated benefit. Six months after surgery, the patient's tremor and dystonic burden had decreased by 67% in the performance sub-score of The Essential Tremor Rating Scale (TETRAS). A patient-tailored approach including target selection guided by individualized anatomy and tractography as well as extra-operative externalized lead interrogation was shown to be effective in optimizing clinical outcome in a patient with refractory post-traumatic tremor.
运动障碍可能是严重创伤性脑损伤常见、持续且使人衰弱的后遗症。创伤后运动障碍本质上通常较为复杂，涉及多种临床表现，仅靠药物治疗可能难以控制。深部脑刺激（DBS）已被用于治疗这些具有挑战性的病例，但创伤继发的脑解剖结构变形会使有效靶点定位变得复杂。在这种情况下，使用弥散张量成像和带外置DBS电极的住院测试有助于优化治疗效果。我们报告一例42岁男性患者，患有严重且致残的创伤后震颤，接受了双侧、双靶点DBS治疗，靶点为内侧苍白球（GPi）以及丘脑腹中间核（Vim）/齿状红核丘脑束（DRTT）联合靶点。鉴于患者解剖结构变形，术前重建了DRTT纤维束以辅助手术靶点定位。术后通过住院测试对四根电极进行外置和检测，以便将显示有疗效的电极植入体内。术后六个月，在原发性震颤评定量表（TETRAS）的运动亚评分中，患者的震颤和肌张力障碍负担减轻了67%。对于一名难治性创伤后震颤患者，采用包括根据个体化解剖结构和纤维束成像指导靶点选择以及术后外置电极检测在内的个体化治疗方法，被证明可有效优化临床疗效。
