Horisawa Shiro, Nonaka Taku, Kohara Kotaro, Mochizuki Tatsuki, Kawamata Takakazu, Taira Takaomi
Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
Stereotact Funct Neurosurg. 2023;101(1):30-40. doi: 10.1159/000528825. Epub 2023 Jan 31.
With the advent of MR-guided focused ultrasound, the importance of the efficacy and safety of bilateral ventral intermediate (Vim) thalamotomy for essential tremor (ET) has increased. However, reports on bilateral Vim thalamotomy for ET remain scarce.
To review the results and complications of bilateral Vim thalamotomy for the treatment of ET in the upper extremities, we retrospectively analyzed the patients with ET who underwent bilateral Vim thalamotomy with radiofrequency (RF) thermal coagulation. As bilateral simultaneous thalamotomy can cause surgical complications, thalamotomy was performed in stages. The interval between the first and second thalamotomies was 21.3 ± 14.7 months. We evaluated the efficacy using the Clinical Rating Scale for Tremor (CRST) before and after the first and second treatments, respectively. We also evaluated the complications before and after the first and second treatments, respectively. Moreover, we assessed the adverse events.
Seventeen patients were included in the study. The mean follow-up period following the second thalamotomy was 29.3 ± 15.0 months. The CRST part A + B scores were 34.9 ± 9.7, 20.8 ± 7.0, and 7.4 ± 6.8 before, following the first (40.4% improvement, p < 0.0001) and second thalamotomies (78.6% improvement, p < 0.0001), respectively. Nine patients presented with prolonged adverse events, including dysarthria, dysgeusia, dysphagia, tongue numbness, unsteady gait, and postural instability at the last available evaluation. All adverse events were mild and did not interfere with the patient's daily activities.
DISCUSSION/CONCLUSIONS: Bilateral Vim thalamotomy with RF thermal coagulation was an effective treatment for ET in both upper extremities. Despite most possible complications being mild, additional studies with a larger sample size are required to ensure patient safety.
随着磁共振引导聚焦超声技术的出现，双侧腹中间核（Vim）丘脑切开术治疗特发性震颤（ET）的有效性和安全性的重要性日益增加。然而，关于双侧Vim丘脑切开术治疗ET的报道仍然很少。
为了回顾双侧Vim丘脑切开术治疗上肢ET的结果和并发症，我们回顾性分析了接受射频（RF）热凝双侧Vim丘脑切开术的ET患者。由于双侧同时丘脑切开术可能导致手术并发症，因此丘脑切开术分阶段进行。第一次和第二次丘脑切开术之间的间隔为21.3±14.7个月。我们分别在第一次和第二次治疗前后使用震颤临床评分量表（CRST）评估疗效。我们还分别在第一次和第二次治疗前后评估并发症。此外，我们评估了不良事件。
17名患者纳入研究。第二次丘脑切开术后的平均随访期为29.3±15.0个月。CRST A+B部分评分在第一次丘脑切开术前、术后分别为34.9±9.7、20.8±7.0，改善了40.4%（p<0.0001）；第二次丘脑切开术后为7.4±6.8，改善了78.6%（p<0.0001）。在最后一次可用评估中，9名患者出现了长期不良事件，包括构音障碍、味觉障碍、吞咽困难、舌麻木、步态不稳和姿势不稳。所有不良事件均为轻度，不影响患者的日常活动。
讨论/结论：射频热凝双侧Vim丘脑切开术是治疗双侧上肢ET的有效方法。尽管大多数可能的并发症较轻，但仍需要更大样本量的进一步研究以确保患者安全。
