双靶点脑深部电刺激术治疗原发性震颤的疗效分析  

Efficacy analysis of dual-target deep brain stimulation for the treatment of essential tremor

作　　者：李红星 彭肖肖 张凯 刘贻哲 王瀚 李超 杜祎祎 宗强[1] Hongxing Li;Xiaoxiao Peng;Kai Zhang;Yizhe Liu;Han Wang;Chao Li;Yiyi Du;Qiang Zong(Department of Neurosurgery,Shengli Oilfield Central Hospital,Dongying 257000,China;Department of Stomatology,Dongying District People's Hospital,Dongying 257000,China)

机构地区：[1]胜利油田中心医院神经外科,山东东营257000 [2]东营区人民医院口腔科,山东东营257000

出　　处：《中华脑科疾病与康复杂志(电子版)》2024年第4期225-229,共5页Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition)

摘　　要：目的评估联合尾侧未定带脑深部电刺激术(cZI-DBS)与丘脑腹中间核脑深部电刺激术(Vim-DBS)治疗原发性震颤(ET)的疗效和安全性。方法回顾性分析胜利油田中心医院神经外科自2020年1月至2023年6月应用双靶点DBS治疗的11例ET患者的临床资料。所有患者术后立即行颅脑CT检查以确认电极位置并排除脑出血和梗死等并发症。采用Fahn-Tolosa-Marin震颤评分量表(FTMTRS)在术前、开机当日及开机后1、3、6和12个月评估患者的运动症状,统计症状改善率,评估治疗的有效性。记录与刺激和手术相关的不良反应,评估治疗的安全性。结果11例患者(2例单侧,9例双侧)均成功完成双靶点DBS手术。术后颅脑CT检查显示电极位置与术前计划靶点相符,患者均体验到微毁损效应。随访26个月(12~42个月),未发现梗死、出血、感染、过敏或排异反应等并发症。术后1个月,患者首次开机时选择cZI核团的触点进行单极刺激,其中2例患者在随访期间调整了触点至Vim靶点。所有患者的震颤症状在术后均有显著改善,开机当天及之后1、3、6和12个月的改善率分别为70.21%、61.34%、67.28%、72.04%和75.04%。开机后出现构音障碍1例,共济失调2例,一过性肢体麻木3例,下肢无力4例,通过调整触点或参数后均消失或耐受。结论cZI-DBS有助于改善ET患者的临床症状,与Vim-DBS联合使用可提高程控的多选择性,减少二次手术重新植入电极事件的风险,且手术并发症少,显示出良好的安全性和可行性。Objective To evaluate the therapeutic efficacy and safety of combined caudal part of the zona incerta(cZI)-deep brain stimulation(DBS)with ventral intermediate nucleus(Vim)-DBS for the treatment of essential tremor(ET).Methods A retrospective analysis of 11 patients with ET treated with dual-target DBS at Neurosurgery Department of Shengli Oilfield Central Hospital from January 2020 to June 2023 were conducted.Postoperatively,all patients underwent immediate cranial CT to confirm electrode placement and to rule out complications such as cerebral hemorrhage and infarction.The Fahn-Tolosa-Marin tremor rating scale(FTMTRS)was used to assess motor symptoms preoperatively,on the day of device activation,and at 1,3,6,and 12 months post-activation to calculate the rate of symptom improvement and to evaluate the effectiveness of the treatment.Additionally,adverse reactions related to stimulation to assess the safety of the treatment were recorded.Results All 11 patients(2 with unilateral and 9 with bilateral treatment)successfully completed the dual-target DBS procedure.Cranial CT scans showed that the electrode positions matched the preoperative planned targets,and all patients experienced a significant microlesion effect postoperatively.The median follow-up time was 26 months(ranging from 12 to 42 months),with no observed complications such as infarction,hemorrhage,infection,allergy,or rejection.At one month postoperatively,during the initial device activation,patients selected monopolar stimulation at contacts in the cZI nucleus,with 2 patients adjusting contacts to the Vim target during follow-up.Tremor symptoms in all patients showed significant improvement postoperatively,with improvement rates on the day of activation and at 1,3,6,and 12 months post-activation being 70.21%,61.34%,67.28%,72.04%,and 75.04%,respectively.Post-activation,adverse reactions included dysarthria in 1 case,ataxia in 2 cases,transient limb numbness in 3 cases,and lower limb weakness in 4 cases,all of which were resolved or tolerated after ad

关 键 词：原发性震颤 脑深部电刺激术 尾侧未定带 丘脑底核后部区域 丘脑腹中间核 双靶点 

分 类 号：R651.1[医药卫生—外科学]