1Department of Clinical and Movement Neurosciences, Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, UCLH-UCL Queen Square Institute of Neurology, London, United Kingdom.
2Neurology Department, Strasbourg University Hospital, Strasbourg, France.
J Neurosurg. 2023 Oct 13;140(4):1148-1154. doi: 10.3171/2023.7.JNS222744. Print 2024 Apr 1.
Radiofrequency thalamotomy (RF-T) is an established treatment for refractory tremor. It is unclear whether connectivity-guided targeting strategies could further augment outcomes. The aim of this study was to evaluate the efficacy and safety of MRI connectivity-guided RF-T in severe tremor.
Twenty-one consecutive patients with severe tremor (14 with essential tremor [ET], 7 with Parkinson's disease [PD]) underwent unilateral RF-T at a single institution between 2017 and 2020. Connectivity-derived thalamic segmentation was used to guide targeting. Changes in the Fahn-Tolosa-Marin Rating Scale (FTMRS) were recorded in treated and nontreated hands as well as procedure-related side effects.
Twenty-three thalamotomies were performed (with 2 patients receiving a repeated intervention). The mean postoperative assessment time point was 14.1 months. Treated-hand tremor scores improved by 63.8%, whereas nontreated-hand scores deteriorated by 10.1% (p < 0.01). Total FTMRS scores were significantly better at follow-up compared with baseline (mean 34.7 vs 51.7, p = 0.016). Baseline treated-hand tremor severity (rho = 0.786, p < 0.01) and total FTMRS score (rho = 0.64, p < 0.01) best correlated with tremor improvement. The most reported side effect was mild gait ataxia (n = 11 patients).
RF-T guided by connectivity-derived segmentation is a safe and effective option for severe tremor in both PD and ET.
射频丘脑切开术（RF-T）是治疗难治性震颤的一种既定方法。目前尚不清楚连接导向靶向策略是否可以进一步提高疗效。本研究旨在评估 MRI 连接导向 RF-T 在严重震颤中的疗效和安全性。
2017 年至 2020 年期间，在一家机构，21 例严重震颤患者（14 例特发性震颤[ET]，7 例帕金森病[PD]）接受了单侧 RF-T。使用连接衍生的丘脑分割来指导靶向。记录治疗手和未治疗手的 Fahn-Tolosa-Marin 评定量表（FTMRS）变化以及与手术相关的副作用。
共进行了 23 次丘脑切开术（2 例患者接受了重复干预）。平均术后评估时间为 14.1 个月。治疗手震颤评分改善了 63.8%，而未治疗手评分恶化了 10.1%（p<0.01）。与基线相比，随访时总 FTMRS 评分明显更好（平均 34.7 对 51.7，p=0.016）。治疗手震颤严重程度的基线（rho=0.786，p<0.01）和总 FTMRS 评分（rho=0.64，p<0.01）与震颤改善的相关性最佳。最常见的不良反应是轻度步态共济失调（11 例患者）。
基于连接衍生分割的 RF-T 是 PD 和 ET 中严重震颤的一种安全有效的治疗选择。
