MRI导向丘脑腹中间核立体定向毁损术治疗书写痉挛二例并文献复习

MRI guided stereotactic ventrointermediate thalamotomy for writer's cramp:two cases report and literature review

目的探讨立体定向手术治疗书写痉挛的方法及疗效。方法与结果采用MRI导向丘脑腹中间核立体定向毁损术治疗2例书写痉挛(震颤型)患者,例1术后书写时震颤即消失,写字较术前工整;例2术后右上肢震颤明显改善,可正常工作和生活。2例患者均未出现明显并发症,术后随访至今均未复发。结论书写痉挛的外科手术疗效明确,MRI导向丘脑腹中间核立体定向毁损术可以精确定位神经核团,有效避免术中并发症。文献复习两种外科手术方法(脑深部电刺激术和脑深部神经核团毁损术)的优劣和适应证,尚待进一步探讨。

Objective To explore the methods and curative effect of stereotactic surgery for treating writer＇s cramp （WC）. Methods and Results Two patients with writer＇s cramp （trenlor type） underwent MRI guided stereotactic ventrointermediate （Vim） thalamotomy on the left side. The symptoms of one patient disappeared immediately after operation, and the patient could write legibly. The tremor of right upper extremity in another patient was improved significantly. Two patients did not present obvious complications, and the previous symptoms were not found to recur during follow-up period respectively. Conclusions Stereotactic surgery for treatment of writer＇s cramp has definite therapeutic effect. MRI guided stereotactic technique can effectively avoid the complications of Vim thalamotomy. However, the indications of two methods in surgical treatment [thalamotomy and deep brain stimulation （DBS）] and the respective merits still need further study.