Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Focused Ultrasound Foundation, Charlottesville, Virginia, USA.
Stereotact Funct Neurosurg. 2022;100(5-6):291-299. doi: 10.1159/000525763. Epub 2022 Aug 26.
The objectives of this study were to determine long-term patient-reported outcomes with magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy for medication-refractory essential tremor (ET) and to identify risk factors for a poor clinical outcome.
We administered a telephone or mail-in survey to patients who consecutively underwent unilateral MRgFUS thalamotomy for ET at our institution over an 8-year period. Patients were asked to self-report measures of hand tremor improvement, degree of overall postprocedure improvement, activities of daily life, side effects, and willingness to undergo the procedure again. Specific patient characteristics, ultrasound treatment parameters, and postoperative radiological findings from magnetic resonance imaging performed 1 day after the procedure were analyzed, and multivariable linear regression was used to determine if these factors could serve as predictors of clinical outcome.
A total of 85 patients were included in this study with a mean follow-up time of 3.0 years (range 2 months to 1 8.4 years). The mean patient-reported improvement in hand tremor at last follow-up was 66%, and 73% of patients reported meaningful change in their overall condition after the procedure. The percentages of patients reporting normal or only minimal limitations with feeding, drinking, and writing ability at last follow-up were 60%, 71%, and 48%, respectively. In the position of their former selves, 89% of patients would again choose to undergo the procedure. Larger lesions were correlated with a higher risk of adverse events.
DISCUSSION/CONCLUSION: While subjective hand tremor improvement declines with time, willingness to undergo the procedure again following MRgFUS thalamotomy for ET remains very high even several years after the procedure.
本研究旨在确定磁共振引导聚焦超声（MRgFUS）丘脑切开术治疗药物难治性特发性震颤（ET）的长期患者报告结局，并确定不良临床结局的风险因素。
我们对在我院接受单侧 MRgFUS 丘脑切开术治疗 ET 的连续患者进行了电话或邮件调查。患者被要求自行报告手部震颤改善程度、整体术后改善程度、日常生活活动、副作用以及是否愿意再次接受该手术。分析了特定患者特征、超声治疗参数以及术后 1 天磁共振成像的影像学发现，采用多变量线性回归分析这些因素是否可作为临床结局的预测因素。
本研究共纳入 85 例患者，平均随访时间为 3.0 年（2 个月至 18.4 年）。末次随访时，患者手部震颤的平均自述改善率为 66%，73%的患者报告术后整体状况有明显改善。最后一次随访时，报告正常或仅轻微限制进食、饮水和书写能力的患者比例分别为 60%、71%和 48%。89%的患者如果回到过去，会再次选择接受该手术。较大的病变与不良事件风险增加相关。
讨论/结论：虽然主观手部震颤改善随时间而下降，但即使在手术多年后，患者对再次接受 ET 的 MRgFUS 丘脑切开术的意愿仍然非常高。
