背景:用于治疗原发性震颤(ET)的磁共振引导聚焦超声(MRgFUS)传统上靶向腹侧中间(Vim)核。最近的策略包括后丘脑下区(PSA)的继发性病变。
目的:目的是比较病变特征,震颤改善,和不良事件(AE)在仅Vim病变即可达到满意的震颤抑制的患者与需要额外PSA病变的患者之间。
方法:对在悉尼圣文森特医院接受MRgFUS治疗的ET患者的数据进行回顾性分析。震颤临床评定量表(CRST),手震颤评分(HTS),除AE的患病率外,还收集治疗前后的原发性震颤生活质量问卷(QUEST)。使用磁共振成像评估病变的坐标和与齿状丘脑(DRTT)的重叠。
结果:21例患者仅接受Vim治疗,14例接受双重Vim-PSA病变治疗。35例患者中有29例(19个单目标和10个双目标)的临床数据可用。在随访(平均:18.80个月)HTS,CRST,单目标患者的QUEST改善了57.97%(P<0.001),36.71%(P<0.001),58.26%(P<0.001),而双目标患者改善了68.34%(P<0.001),35.37%(P<0.003),46.97%(P<0.005),分别。双目标患者的Vim病变相对于后连合(PC)(7.84mm)更靠前,与单目标患者(6.92毫米)相比,DRTT参与较少(14.85%vs.23.21%)。双目标患者表现出更大比例的急性运动性AE患者(100%vs.58%);然而,长期随访时,两组的运动性AE患病率相似(33%vs.38%)。
结论:以Vim为目标的病变的后部放置可能会产生更大的震颤抑制。增加了一个PSA损伤,在震颤控制不足的患者中,尽管有Vim病变,有更好的长期震颤抑制趋势;然而,这种方法在短期内与更高的步态障碍患病率相关.
BACKGROUND: Magnetic resonance-guided focused ultrasound (MRgFUS) for treatment of essential tremor (ET) traditionally targets the ventral intermediate (Vim) nucleus. Recent strategies include a secondary lesion to the posterior subthalamic area (PSA).
OBJECTIVE: The aim was to compare lesion characteristics, tremor improvement, and adverse events (AE) between patients in whom satisfactory tremor suppression was achieved with lesioning of the Vim alone and patients who required additional lesioning of the PSA.
METHODS: Retrospective analysis of data collected from ET patients treated with MRgFUS at St Vincent\'s Hospital Sydney was performed. Clinical Rating Scale for Tremor (CRST), hand tremor score (HTS), and Quality of Life in Essential Tremor Questionnaire (QUEST) were collected pre- and posttreatment in addition to the prevalence of AEs. The lesion coordinates and overlap with the dentatorubrothalamic tract (DRTT) were evaluated using magnetic resonance imaging.
RESULTS: Twenty-one patients were treated in Vim only, and 14 were treated with dual Vim-PSA lesions. Clinical data were available for 29 of the 35 patients (19 single target and 10 dual target). At follow-up (mean: 18.80 months) HTS, CRST, and QUEST in single-target patients improved by 57.97% (P < 0.001), 36.71% (P < 0.001), and 58.26% (P < 0.001), whereas dual-target patients improved by 68.34% (P < 0.001), 35.37% (P < 0.003), and 46.97% (P < 0.005), respectively. The Vim lesion of dual-target patients was further anterior relative to the posterior commissure (PC) (7.84 mm), compared with single-target patients (6.92 mm), with less DRTT involvement (14.85% vs. 23.21%). Dual-target patients exhibited a greater proportion of patients with acute motor AEs (100% vs. 58%); however, motor AE prevalence was similar in both groups at long-term follow-up (33% vs. 38%).
CONCLUSIONS: Posterior placement of lesions targeting the Vim may confer greater tremor suppression. The addition of a PSA lesion, in patients with inadequate tremor control despite Vim lesioning, had a trend toward better long-term tremor suppression; however, this approach was associated with greater prevalence of gait disturbance in the short term.