经颅磁共振引导超声聚焦治疗帕金森病震颤的初步观察  

Preliminary observation of transcranial MR-guided focused ultrasound in the treatment of tremor related to Parkinson’s disease

作　　者：宗睿[1] 李雪梅[2] 何建风 张德康 余新光[1] 凌至培[1] 赵珺燕[1] 马林[3] 娄昕[3] 潘隆盛[1] Zong Rui;Li Xuemei;He Jianfeng;Zhang Dekang;Yu Xinguang;Ling Zhipei;Zhao Junyan;Ma Lin;Lou Xin;Pan Longsheng(Department of Neurosurgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Cadre Clinic,Neurology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Radiology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心神经外科,北京100853 [2]解放军总医院第一医学中心门诊部干部诊疗科神经内科,北京100853 [3]解放军总医院第一医学中心放射诊断科,北京100853

出　　处：《中华神经外科杂志》2020年第11期1130-1134,共5页Chinese Journal of Neurosurgery

基　　金：国家老年疾病临床医学研究中心开放课题(NCRCG-PLAGH-2019005)。

摘　　要：目的观察经颅磁共振引导超声聚焦(简称磁波刀)治疗震颤为主型帕金森病(TDPD)患者的安全性和有效性。方法前瞻性纳入2019年4—9月解放军总医院第一医学中心神经外科收治的10例TDPD患者。所有患者采用磁波刀行主要症状侧的丘脑腹中间核(Vim)毁损术。观察术后不良反应的发生情况。采用混合效应线性模型比较术前、术后1个月与术后3个月临床震颤评定量表(CRST)评分,以评价对震颤症状的治疗效果。结果10例患者中,7例采用磁波刀行左侧Vim毁损术、3例行右侧Vim毁损术。10例患者给予超声波能量次数为(10.4±2.6)次;初始治疗能量范围为849~2823 J,最终能量范围6737~20096 J,最高治疗温度为(56.7±1.7)℃。患者进入治疗室至出治疗室耗时的中位数(上、下四分位数)为140.0(13.0,182.5)min,从首次到末次给予超声能量的耗时为(62.3±25.4)min。患者术后头颅MRI显示,在治疗侧Vim区域可见直径约5 mm的消融斑。所有患者均在术后3个月的时间窗内完成随访。术后3个月与术前基线比较,CRST总分、CRST A部分评分、B部分评分、C部分评分、治疗侧上肢及治疗侧下肢震颤评分均降低,差异均有统计学意义(均P<0.05);但与术后1个月比较,以上评分的差异均无统计学意义(均P>0.05)。术后出现头皮、唇部或舌尖麻木5例、肌力下降2例、平衡障碍2例;至末次随访,3例麻木缓解,2例改善,2例肌力恢复,2例平衡功能恢复,但1例疾病进展(出现步态障碍)。结论初步观察发现,应用磁波刀治疗TDPD患者的震颤症状,其短期疗效和安全性均较好。Objective To assess the safety and effectiveness of transcranial MR-guided focused ultrasound(tcMRgFUS)in the treatment of tremor-dominant idiopathic Parkinson′s disease(TDPD).Methods A prospective study was conducted on 10 patients with TDPD who were admitted to Department of Neurosurgery,the First Medical Center of PLA General Hospital from April to September 2019.All patients underwent unilateral(dominant side)tcMRgFUS ablation of Vim(ventrointermediate)nucleus of thalamus.The occurrence of adverse events after surgery were documented.A linear mixed model was used to compare the clinical rating scale for tremor(CRST)score before operation,1 month and 3 months after operation to evaluate the effect of treatment.Results Among 10 patients,7 cases underwent Vim ablation through tcMRgFUS on the left side and 3 cases underwent the operation on the right side.For 10 patients,sonications transmitted were 10.4±2.6 times;the initial treatment energy ranged from 849 to 2823 J,the final energy ranged from 6737 to 20096 J,and the highest treatment temperature was 56.7±1.7℃.The median(Q25,Q75)time period from entering to leaving the treatment room was 140.0(13.0,182.5)min,and the time from the first to the last sonication was 62.3±25.4 min.After operation,MRI revealed the ablation site with a diameter of 5 mm in the area of Vim nucleus on the treatment side.All patients completed follow-up within 3 months after surgery.At 3 months after operation,CRST total score,CRST part A,part B,part C,(treatment side)upper extremity and lower extremity tremor scores were all significantly decreased compared with preoperative baseline(all P<0.05).However,those were not significantly different compared with 1 month post operation(all P>0.05).Postoperative adverse events included numbness of the scalp,lips or tip of the tongue(5 cases),decreased muscle strength(2 cases),and equilibrium disturbance(2 cases).Among 5 cases of numbness,3 cases were relieved and 2 cases were improved at the last follow-up.The muscle strength was recovere

关 键 词：帕金森病 震颤 治疗结果 磁共振引导超声聚焦 丘脑腹中间核 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R445[医药卫生—临床医学]