立体定向丘脑腹中间核毁损术治疗书写痉挛的疗效评估

目的探讨丘脑腹中间(Vim)核毁损术治疗书写痉挛的有效性和安全性。方法采用微电极引导下左侧丘脑Vim核毁损治疗书写痉挛(WC)患者47例,其中男32例,女15例;年龄15~64岁,平均(28.9±10.7)岁;病程2~21年。在术前和术后,采用书写痉挛评分量表(the writer's cramp rating scale,WCRS)对患者进行评分。结果全部患者毁损手术当时症状就明显改善,肘部、腕部和手指痉挛明显缓解,写字的流利程度和速度明显提升。其中2例患者(4.2%)出现一过性的右手指尖麻木;另有3例患者(6.4%)出现一过性言语不流利;上述并发症在3个月内完全恢复,没有永久性并发症发生。术后对患者进行电话随访,随访时间6~36个月,平均23个月;结果显示,患者的症状改善稳定;其中有3例患者失随访。另外,有1例患者因症状反复,再次行丘脑Vim核毁损术,术后症状改善明显。结论丘脑Vim核毁损术治疗书写痉挛是一种有效、安全的手术方式。

Stereotactic selective thalamotomy for treatment of writer's cramp

Objective To explore the efficacy and safety of stereotactic selective thalamotomy for the treatment of writer's cramp( WC) .Methods 47 patients(32 men,15 women,age 15-64 years, mean 28.9 years) with medically intractable task-specific focal dystonia of the hand underwent Vim thalamotomy.The stereotactic target was chosen at ventralis intermedius nucleus. The mean duration of the symptom ranged from 2 to 21 years ( mean 5 .5 years ) .Results All patients showed immediate postoperative disappearance of dystonic symptoms , and the effect was sustained during the follow-up period ( 6-36 months, mean 23 months ) , except in 3 cases.One patient showed partial recurrence of the symptom and underwent second thalamotomy 6 months after the initial surgery with satisfactory results.The score on WC rating scale decreased significantly (P<0.001) after Vim thalamotomy.There were no permanent operative complications.There was no mortality or permanent morbidity.Conclusion Although a longer follow-up is needed, stereotactic Vim thalamotomy is a useful and safe therapeutic option for writer's cramp.