脑立体定向手术治疗Meige综合征二例报告并文献复习  

Stereotactic neurosurgery for Meige syndrome： two cases reports and literature review

作　　者：王林[1] 陈国强[1] 梁晖[1] 王晓松[1] 

机构地区：[1]清华大学玉泉医院神经外科二病区,北京100049

出　　处：《中华神经外科杂志》2012年第2期193-196,共4页Chinese Journal of Neurosurgery

基　　金：清华大学裕元科学基金（20240000534）

摘　　要：目的探讨立体定向深部脑刺激术（DBS）和脑内核团毁损术在Meige综合征（MS）中的临床应用。方法2例患者术前均采用Burke-Fahn-Marsden肌张力障碍运动评分（BFMDRS），l例MS患者行双侧苍白球内侧核（GPi）DBS手术治疗，1例患者行单侧GPi射频毁损术治疗。结果行双侧GPi-DBS患者术后随访1年改善达83．7％（BFMDRS评分由术前的22．5分减少为4分），随访2年改善率达69．1％左右（BFMDRS评分由22．5分减少为6分），疗效较为稳定。1例行立体定向右侧GPi毁损术，术后1周疗效明显，BFMDRS从28分减少到6分，改善达78．6％；术后3个月BFMDRS评分为15分，改善率为46．2％，术后6个月随访，所有症状恢复到术前水平。结论双侧GPi-DBS对于传统治疗无效的Meige综合征患者是一种安全有效的治疗方法；对于不能接受DBS手术的患者，行苍白球或丘脑毁损手术也是值得推荐的一种方法。Objective Meige syndrome （MS） is the combination of blepharospasm and oromandibular dystonia. We assessed the surgical results of bilateral globus pallidus internus （GPi） deep brain stimulation （DBS） and unilateral pallidotomy in patients with medically refractory MS. 2 case reports are presented, and the diagnostic, therapeutic and etiology issues outlined by reviewing the literature. Methods Symptoms were evaluated according to the Burke - Fahn - Marsden dystonia rating scale （BFMDRS）. We report a case of a 48 - year - old man with bilateral manifestation of Meige syndrome （MS） successfully treated with Bilateral GPi - DBS. Right - side unilateral pallidotomy has been used with another 45 - year - old man. Results Stereotactic bilateral GPi - DBS of the pallidum led to a dramatic clinical improvement. BFMDRS score showed an improvement of 83.7% and 69. 1% on the 12 and 24month follow - up. The patient of unilateral pallidotomy BFMDRS score showed an improvement of 78.6% and 46. 2% on the 1 week and 3 month follow - up. Symptoms were no improvement in 6month follow - up. Conclusions Pallidotomy or thalamotomy is recommended for the treatment of MS in patients on whom deep brain stimulation could not be performed. Stereotactic bilateral GPi DBS may be an effective and safe treatment for primary Meige syndrome who obtain disappointing results from conventional treatment.

关 键 词：MEIGE综合征 苍白球内侧核 深部脑刺激术 苍白球切开术 肌张力障碍 

分 类 号：R651.1[医药卫生—外科学]