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

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。

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

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.