立体定向下丘脑Vim核毁损术治疗特发性震颤的相关因素分析

The study of the related factors on stereotactic thalamotomy for essential tremor

目的探讨立体定向下丘脑腹中间核(Vim核)毁损术治疗特发性震颤(essentialtremor,ET)的疗效及相关因素。方法回顾性分析微电极导向下单侧丘脑毁损术治疗的55例ET患者。对患者术前术后肢体震颤、生活功能改善情况进行评估,对并发症、症状复发及手术适应证进行分析。结果手术对侧肢体震颤完全消失47例,遗留有轻微震颤8例,头颈、躯干部震颤及声音震颤有所改善,同侧肢体震颤无缓解,震颤的整体改善率54.1%,术后复发3例,同侧二次手术后震颤完全控制。长期随访疗效稳定,患者生活质量明显提高。一过性并发症15例,无永久性并发症。结论立体定向单侧Vim核毁损术治疗ET是一种安全、有效的方法,微电极引导准确定位是手术成功的保障,症状复发及并发症的出现与靶点定位不准及毁损灶大小有关。

Objective To explore the effects and complications of stereotactic thalamotomy for essential tremor. Methods Total 55 ET patients who accepted unilateral thalamotomy with microelectrode-guided technique to locate Vim nuclens. The improvement of the limb tremor and vital function were evaluated pre and post-operation, the complication, indications and question of recovery were analyzed in a retrospective study. Results 47 patients＇s opposite limb tremor disappeared completely,8 cases remain slight limb tremor, the tremor of head, neck, trunk and voice only had a slight improvement. homonymy limb symptomshadn＇ t help. The entirety tremor improved 54.1%, 3 patients were accepted a second operations after setback. The curative effect was stable, the patients＇s quality of life had improvement obviously. 15 cases got a transient complications, no permanent complications occurred. Conclusion It is safe and effective that stereotactic unilateral thalamotomy for ET. It is important to locate accurately Vim nuclens with microelectrode - guided technique. The rate of recovery and complication were concerned with an imprecise orientation and size of damaged volume.