脑室扩大患者原发性震颤的脑深部电刺激治疗
Deep brain stimulation for essential tremor in patients with ventriculomegaly.
作者信息
Bouttelgier Robin, Vandamme Stijn, Ververken Frédéric, Maenhoudt Wim, Du Four Stephanie, Van Lerbeirghe Jeroen, Vanhauwaert Dimitri, Van Damme Olivier
机构信息
Department of Neurosurgery, AZ Delta, Roeselare, Belgium.
出版信息
Surg Neurol Int. 2024 Jul 19;15:249. doi: 10.25259/SNI_979_2023. eCollection 2024.
BACKGROUND
Deep brain stimulation of the nucleus ventralis intermedius (VIM-DBS) is considered a safe and effective treatment for medically intractable essential tremor (ET). However, ventriculomegaly can provide a surgical challenge, as there is an increased risk of breaching the ventricle during the procedure, with potential risk of intraventricular hemorrhage and target displacement.
CASE DESCRIPTION
In this case series, we report successful bilateral VIM-DBS in a 72-year-old and 69-year-old female ET patient with significant ventriculomegaly. VIM-DBS therapy provided an excellent tremor response. After 5 years, a ventriculoperitoneal shunt was implanted in the first patient due to an incomplete Hakim-Adams triad, with significant improvement in gait and cognition.
CONCLUSION
To the best of our knowledge, we present the first report on VIM-DBS in ET patients with ventriculomegaly and illustrate that VIM-DBS can provide an excellent tremor response in patients with medically intractable ET, even in the context of marked ventriculomegaly.
背景
丘脑腹中间核深部脑刺激术（VIM-DBS）被认为是治疗药物难治性特发性震颤（ET）的一种安全有效的方法。然而，脑室扩大可能带来手术挑战，因为手术过程中穿破脑室的风险增加，存在脑室内出血和靶点移位的潜在风险。
病例描述
在本病例系列中，我们报告了在一名72岁和一名69岁患有明显脑室扩大的女性ET患者中成功进行双侧VIM-DBS的情况。VIM-DBS治疗产生了极佳的震颤缓解效果。5年后，第一名患者因哈基姆-亚当斯三联征不完全而植入了脑室腹腔分流管，步态和认知有显著改善。
结论
据我们所知，我们首次报告了在脑室扩大的ET患者中进行VIM-DBS的情况，并表明VIM-DBS即使在明显脑室扩大的情况下，也能为药物难治性ET患者提供极佳的震颤缓解效果。
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