Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, China.
Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, China.
Acta Neurochir (Wien). 2024 Oct 21;166(1):420. doi: 10.1007/s00701-024-06315-4.
Intraventricular baclofen has been reported as an alternative to intrathecal baclofen for managing refractory spasticity and dystonia in some circumstances. In this report, we described a frame-based stereotactic approach for precisely positioning of the infusion catheter into the third ventricle.
High resolution contrast-enhanced anatomical MR sequences was acquired prior to surgery for pre-planning. Catheter trajectory was planned to pass from the lateral ventricle to the third ventricle through the Foramen of Monro. The surgical procedure was adapted from the frame-based deep brain stimulation surgery. The Touch-Loc kit (SceneRay, China) was used to temporarily secure the catheter in place during the surgery. From July 2022 to December 2022, three patients suffering from intractable spasticity and/or secondary dystonia received IVB successfully using the described technique.
No severe adverse events, including death, intracranial hemorrhage, infection, catheter migration or fracture, were documented at the last follow-up (range: 12‒24 months). Transient side effects included mild nausea following the initiation of infusion or the increase in infusion rate. All three patients responded to the IVB.
The described frame-based stereotactic technique for IVB catheter implant is feasible and could be quickly mastered by neurosurgeons in related fields. Larger prospective cohorts with longer follow-up periods are necessary to further evaluate the long-term safety and efficacy of this procedure.
在某些情况下，脑室内巴氯芬已被报道可作为鞘内巴氯芬的替代方法，用于治疗难治性痉挛和肌张力障碍。在本报告中，我们描述了一种基于框架的立体定向方法，可精确将输注导管定位到第三脑室。
在手术前获取高分辨率对比增强解剖磁共振序列进行术前规划。导管轨迹规划为从侧脑室经 Monro 孔进入第三脑室。手术过程改编自基于框架的深部脑刺激手术。Touch-Loc 套件（SceneRay，中国）用于在手术过程中临时固定导管。自 2022 年 7 月至 2022 年 12 月，使用描述的技术，3 名患有难治性痉挛和/或继发性肌张力障碍的患者成功接受了 IVB。
在最后一次随访（12-24 个月）时，没有记录到任何严重不良事件，包括死亡、颅内出血、感染、导管移位或骨折。短暂的副作用包括输注开始或输注速度增加后轻度恶心。所有 3 名患者对 IVB 均有反应。
描述的基于框架的立体定向 IVB 导管植入技术是可行的，相关领域的神经外科医生可以快速掌握。需要更大的前瞻性队列和更长的随访期来进一步评估该手术的长期安全性和疗效。
