目的:运动皮质刺激(MCS)是治疗某些患者慢性顽固性疼痛的有效技术。然而,大多数研究是小案例系列(n<20)。技术和患者选择的异质性使得难以得出一致的结论。在这项研究中,我们介绍了硬膜下MCS最大的病例系列之一。
方法:回顾了2007年至2020年在我们研究所接受MCS的患者的病历。总结了至少15名患者的研究以进行比较。
结果:该研究包括46名患者。平均年龄为56.2±12.5岁(SD)。平均随访57.2±41.9个月。男女比例为13:33。46名患者中,29例三叉神经区神经性疼痛/麻醉多洛洛萨;9例术后/创伤后疼痛;3例幻肢疼痛;2例带状疱疹后疼痛,其余的疼痛继发于中风,慢性局部疼痛综合征,和肿瘤。基线数字疼痛评分(NRS)为10分之8.2±1.8,最新随访评分为3.5±2.9(平均改善57.3%)。响应者占67%(31/46)(NRS≥40%改善)。分析显示改善的百分比与年龄之间没有相关性(p=0.352),但男性患者占优势(75.3%vs48.7%,p=0.006)。47.8%的患者(22/46)在某些时候发生癫痫发作,但都是自限性的,没有持久的后遗症.其他并发症包括需要疏散的硬膜下/硬膜外血肿(3/46),感染(5/46),脑脊液漏(1/46)。进一步干预后,这些并发症得以解决,没有长期后遗症。
结论:我们的研究进一步支持使用MCS作为几种慢性顽固性疼痛的有效治疗方式,并为当前文献提供了基准。
OBJECTIVE: Motor cortex stimulation (MCS) is an effective technique in treating chronic intractable pain for some patients. However, most studies are small case series (n < 20). Heterogeneity in technique and patient selection makes it difficult to draw consistent conclusions. In this study, we present one of the largest case series of subdural MCS.
METHODS: Medical records of patients who underwent MCS at our institute between 2007 and 2020 were reviewed. Studies with at least 15 patients were summarized for comparison.
RESULTS: The study included 46 patients. Mean age was 56.2 ± 12.5 years (SD). Mean follow-up was 57.2 ± 41.9 months. Male-to-female ratio was 13:33. Of the 46 patients, 29 had neuropathic pain in trigeminal nerve territory/anesthesia dolorosa; nine had postsurgical/posttraumatic pain; three had phantom limb pain; two had postherpetic pain, and the rest had pain secondary to stroke, chronic regional pain syndrome, and tumor. The baseline numeric rating pain scale (NRS) was 8.2 ± 1.8 of 10, and the latest follow-up score was 3.5 ± 2.9 (mean improvement of 57.3%). Responders comprised 67% (31/46)(NRS ≥ 40% improvement). Analysis showed no correlation between percentage of improvement and age (p = 0.352) but favored male patients (75.3% vs 48.7%, p = 0.006). Seizures occurred in 47.8% of patients (22/46) at some point but were all self-limiting, with no lasting sequelae. Other complications included subdural/epidural hematoma requiring evacuation (3/46), infection (5/46), and cerebrospinal fluid leak (1/46). These complications resolved with no long-term sequelae after further interventions.
CONCLUSIONS: Our study further supports the use of MCS as an effective treatment modality for several chronic intractable pain conditions and provides a benchmark to the current literature.