丘脑腹中间核损毁和电刺激治疗以震颤为主的运动障碍性疾病的临床价值

Treatment of dyskinetic disorders with tremor by lesioning and DBS of Vim

目的 探讨现代立体定向手术治疗以震颤为主的运动障碍性疾病的方法及解剖定位和微电极功能定位的价值。方法 应用手术计划系统和微电极导向技术对 2 2例病人进行丘脑腹中间核 (Vim)定位 ,然后行靶点损毁术和电刺激 (DBS)手术。结果 2 2例病人 ,术中有 2 1例震颤完全消失 ,有 13例肌张力不同程度缓解。随访 6～ 12个月 ,有 18例患者震颤完全消失 ,其中包括 3例DBS手术的病人 ;3例明显缓解 ,1例轻度改善。术中有 17例 1次记录到典型的震颤细胞放电。结论 定位准确是手术成功的关键 。

Objective To explore the effect of stereotactic operation in treatment of dyskinetic disorders with tremor as the main symptom and to study the value of anatomic location and microelectrode functional location. Methods Surgiplan system and microelectrode direction technique were used to locate the Vim, and then target lesioning and deep brain simulation (DBS) were performed in 22 patients with dyskinetic disorders with tremor. After the operation, a follow up was conducted for 6～12 months. Results After the operation, tremor disappeared in 21 patients and hypermyotonia was improved in 13 cases. During the follow up tremor completely disappeared in 18 patients, including 3 cases treated with DBS, was markedly alleviated in 3 cases and was slightly improved in one case. Typical cell firing at tremor was recorded in 17 cases during the operation. Conclusion The surgiplan system and microelectrode recording technique play an important role in location of Vim. Accurate location is crucial for success of operation. The curative effect of DBS is similar as lesioning operation.