Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
World Neurosurg. 2023 Jul;175:e90-e96. doi: 10.1016/j.wneu.2023.03.033. Epub 2023 Mar 11.
Gamma knife (GK) thalamotomy has been used as a treatment option for essential tremor (ET). Numerous studies on GK use in ET treatment have reported more varied responses and complication rates.
Data from 27 patients with ET who underwent GK thalamotomy were retrospectively analyzed. The Fahn-Tolosa-Marin Clinical Rating Scale for Tremor, handwriting, and spiral drawing were evaluated. Postoperative adverse events and magnetic resonance imaging findings were also evaluated.
The mean age at GK thalamotomy was 78.1 ± 4.2 years. The mean follow-up period was 32.5 ± 19.4 months. The preoperative postural tremor, handwriting, and spiral drawing scores were 3.4 ± 0.6, 3.3 ± 1.0, and 3.2 ± 0.8, respectively, all of which showed significant improvements to 1.5 ± 1.2 (55.9% improvement, P < 0.001), 1.4 ± 1.1 (57.6% improvement, P < 0.001), and 1.6 ± 1.3 (50% improvement, P < 0.001), respectively, at the available final follow-up evaluations. Three patients presented with no improvement in tremor. Six patients presented with adverse effects, including complete hemiparesis, foot weakness, dysarthria, dysphagia, lip numbness, and finger numbness, at the final follow-up period. Two patients presented with serious complications, including complete hemiparesis due to massive widespread edema and chronic encapsulated expanding hematoma. One patient died of aspiration pneumonia following severe dysphagia secondary to chronic encapsulated expanding hematoma.
GK thalamotomy is an efficient procedure for treating ET. Careful treatment planning is necessary to reduce complication rates. The prediction of radiation complications will increase the safety and effectiveness of GK treatment.
伽玛刀（GK）丘脑切开术已被用作原发性震颤（ET）的治疗选择。许多关于 GK 在 ET 治疗中应用的研究报告了更不同的反应和并发症发生率。
回顾性分析了 27 例接受 GK 丘脑切开术的 ET 患者的数据。评估了震颤、手写和螺旋绘图的 Fahn-Tolosa-Marin 临床评分量表。还评估了术后不良事件和磁共振成像发现。
GK 丘脑切开术的平均年龄为 78.1±4.2 岁。平均随访时间为 32.5±19.4 个月。术前姿势性震颤、手写和螺旋绘图评分分别为 3.4±0.6、3.3±1.0 和 3.2±0.8，均显著改善至 1.5±1.2（55.9%改善，P<0.001）、1.4±1.1（57.6%改善，P<0.001）和 1.6±1.3（50%改善，P<0.001），分别在可获得的最终随访评估时。3 例患者的震颤无改善。6 例患者在最终随访时出现不良反应，包括完全偏瘫、足无力、构音障碍、吞咽困难、嘴唇麻木和手指麻木。2 例患者出现严重并发症，包括因广泛水肿和慢性包膜扩张性血肿导致的完全偏瘫。1 例患者因慢性包膜扩张性血肿继发严重吞咽困难导致吸入性肺炎死亡。
GK 丘脑切开术是治疗 ET 的有效方法。为降低并发症发生率，需要仔细进行治疗计划。预测放射性并发症将提高 GK 治疗的安全性和有效性。
