难治性抽动秽语综合征伴强迫症的立体定向手术治疗

目的 总结立体定向手术毁损一侧丘脑腹外侧核(VL)/板中间核(LM)联合未定带(ZI)和双侧扣带回前部(ACG)毁损治疗抽动秽语综合征(GTS)伴强迫症的经验.方法 术前录像记录患者平静下抽动情况.手术采用磁共振引导下立体定向射频毁损方式,一侧ZI+VL/LM毁损控制抽动症状,双侧AC毁损控制强迫症状.抽动严重程度以耶鲁大体抽动量表(YGTSS)评价,强迫行严重程度以耶鲁布朗强迫症量表(YBOCS)评价.结果 23例患者接受一侧ZI+VL/LM联合双侧ACG毁损术,其中左侧ZI+VL/LM毁损14例,右侧ZI+VL/LM 9例.术后患者肢体抽动较术前明显改善,其YGTSS评分由术前(20.3±7.2)分明显下降至术后(9.8±3.2)分(P<0.05);术后患者不自主发声显著缓解,其YGTSS评分由术前(19.6±8.8)分明显下降至术后(10.2±3.1)分(P<0.05);术后患者总体病情、生活质量显著提高,其YGTSS评分由术前(70.3±17.2)分明显下降至术后(30.8±10.9)分(P<0.05).另外,术后强迫症也明显缓解,其YBOCS评分由术前(37.2±3.9)分明显下降至术后(17.2±3.2)分(P<0.05).23例患者均未出现严重并发症.结论 一侧VL/LM联合ZI区和双侧ACG毁损术可有效地控制GTS,对GTS伴发的强迫症也有良好的疗效.

Stereotactic surgery for intractable Tourette syndrome accompanied with obsessive-compulsive disorder

Objective To summarize the experiences in treating Tourette syndrome and obsessive-compulsive (OC) disorder by stereotactic surgery. Methods Twenty-three patients were examined by electroencephalography, brain imaging, and brain positron emission tomography before the operation. The severities of tics and OC behavior were evaluated respectively by Yale Global Tics Scale Score (YGTSS) and Yale-Brown Obsessive Compulsive Scale (YBOCS) in all the patients. Tics of the patients were videoed in a quiet situation. The unilateral zona incerta (ZI), ventrolateral nuclei (VLN) or lamella medialis (LM) of the thalami and the bilateral anterior cingulate gyrus (ACG) were lessoned by radiofrequency heating for controlling tics and OC disorder. The prognoses in all the patients were evaluated during the follow-up from 23 months to 36 months after the surgery. Results The motor and phonic tics and overall impairment of Tourette syndrome evaluated by YGTSS were improved significantly after the surgery compared to those before the surgery (P<0.05). The severity of OC disorder was also significantly relieved after the surgery compared to that before the surgery. No severe complications occurred in the patients. Conclusions The motor and phonic tics may be effectively controlled by lesions of ZI, VLN or LM of the thalami. The OC disorder symptoms are significantly relieved by the lesion of ACG in the patients with intractable Tourette syndrome accompanied with obsessive-compulsive disorder.