背景:腹侧中核(Vim)的深部脑刺激(DBS)为医学难治性特发性震颤(ET)提供了安全有效的治疗方法。然而,DBS在老年患者和缺血性脑损伤患者中可能存在风险。伽玛刀放射外科(GKS)是一种微创手术,但双侧丘脑切开术很危险.
方法:我们报告了一例患有医学上顽固性ET的高龄患者,用于优势手震颤的口腹前核(Voa)DBS加用于非优势手震颤的VoaGKS。
方法:一名83岁的右撇子妇女因医学上难以治疗的内皮素来我院就诊。因为右基底节的缺血性病变,我们决定进行左单边DBS而不是双边DBS。
方法:我们选择Voa作为DBS的目标,因为,临床上,她的震颤主要局限在她的手上,Voa的术中微电极记录结果优于Vim。
结果:2年后,她的右手震颤仍处于改善状态,但她的左手仍然有严重的震颤。因此,我们针对正确的Voa执行了GKS。手术一年后,患者的手震颤成功改善,没有任何并发症。
结论:单侧VoaDBS后挽救VoaGKS对于高龄患者和缺血性脑损伤患者是一种有价值的选择。我们建议VoaGKS丘脑切开术与VimGKS一样有用且安全,可用于治疗肌张力障碍手震颤。据我们所知,这是首例使用救助Voa作为ET的唯一目标的病例报告.
BACKGROUND: Deep brain stimulation (DBS) of the ventralis intermedius nucleus (Vim) provides a safe and effective therapy for medically refractory essential tremor (ET). However, DBS may be risky in elderly patients and those with ischemic brain lesions. Gamma Knife radiosurgery (GKS) is a minimally invasive procedure, but bilateral thalamotomy is dangerous.
METHODS: We report a
case of ventralis oralis anterior nucleus (Voa) DBS for dominant hand tremor plus Voa GKS for nondominant hand tremor in a very elderly patient with medically intractable ET.
METHODS: An 83-year-old right-handed woman visited our hospital with a medically intractable ET. Because of the ischemic lesion in the right basal ganglia, we decided to perform left unilateral DBS instead of bilateral DBS.
METHODS: We chose Voa as the target for DBS because, clinically, her tremor was mainly confined to her hands, and Voa had better intraoperative microelectrode recording results than Vim.
RESULTS: After 2 years, her right-hand tremor remained in an improved state, but she still had severe tremor in her left hand. Therefore, we performed GKS targeting the right Voa. One year after surgery, the patient\'s hand tremor successfully improved without any complications.
CONCLUSIONS: Salvage Voa GKS after unilateral Voa DBS is a valuable option for very elderly patients and patients with ischemic brain lesions. We suggest that Voa GKS thalamotomy is as useful and safe a surgical technique as Vim GKS for dystonic hand tremor. To the best of our knowledge, this is the first
case report using salvage Voa as the only target for ET.