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首页> 外文期刊>Neurosurgery >Thalamic deep brain stimulation for essential tremor: relation of lead location to outcome.
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Thalamic deep brain stimulation for essential tremor: relation of lead location to outcome.

机译：丘脑深部脑刺激引起的基本震颤：导线位置与预后的关系。

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OBJECTIVE: Thalamic deep brain stimulation (DBS) is commonly used to treat essential tremor, but the optimal lead location within the thalamus has not been systematically evaluated. We examined the relation of lead location to clinical outcome in a series of essential tremor patients treated by thalamic DBS. METHODS: Fifty-seven leads in 37 patients were studied. Lead locations were measured by postoperative magnetic resonance imaging. Contralateral arm tremor was assessed in the DBS-on and DBS-off states using the Fahn-Tolosa-Marin tremor rating scale, with a mean follow-up of 26 months. Lead locations were statistically correlated, using analysis of variance, with percent improvement in tremor resulting from DBS activation. RESULTS: Improvement in tremor score was significantly correlated with lead location in both the anteroposterior and lateral dimensions. In the plane of the commissures, the optimal electrode location was determined statistically to be 6.3 mm anterior to the posterior commissure and 12.3 mm lateral to the midline, or 10.0 mm lateral to the third ventricle. CONCLUSION: Optimal electrode location for thalamic DBS in essential tremor corresponds to the anterior margin of the ventralis intermedius nucleus. Leads located greater than 2 mm (in the plane of the commissures) from the optimal coordinates are more likely to be associated with poor tremor control than leads within 2 mm of the optimal location. The incidence of true physiological tolerance to the antitremor effect of thalamic DBS (defined as poor tremor control in spite of lead location within 2 mm of the optimal site) was found to be 9%.
机译：目的：丘脑深部脑刺激（DBS）通常用于治疗原发性震颤，但尚未系统评估丘脑内最佳导线位置。我们检查了一系列由丘脑DBS治疗的原发性震颤患者的铅位置与临床结局的关系。方法：对37例患者的57条线索进行了研究。通过术后磁共振成像测量导线位置。使用Fahn-Tolosa-Marin震颤评定量表评估DBS-on和DBS-off状态下的对侧手臂震颤，平均随访26个月。使用方差分析，铅位置与DBS激活导致的震颤改善百分比在统计上相关。结果：震颤评分的改善与前后和横向尺寸的铅位置显着相关。在连合平面中，统计上确定最佳电极位置为连合后前方6.3 mm，中线外侧12.3 mm，或第三脑室侧10.0 mm。结论：丘脑DBS在原发性震颤中的最佳电极位置对应于中间腹侧腹核的前缘。与最佳位置2 mm之内的导线相比，距离最佳坐标2mm（在合缝平面内）的导线更可能与震颤控制不良有关。发现对丘脑DBS的抗震颤作用的真正生理耐受性发生率（定义为尽管在最佳部位的2 mm之内有铅位置，但震颤控制不佳）的发生率为9％。

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