Stereotactic and functional neurosurgery · 2025
Asleep Deep Brain Stimulation for Essential Tremor.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Harland Tessa A, Gupta Shruti, Hefner Matthew, Wilden Jessica
Аннотация
INTRODUCTION: Deep brain stimulation (DBS) was approved for essential tremor by the Food and Drug Administration (FDA) in 1997. Since that time, technological advancements in implanted hardware and operative technique have changed the landscape of functional neurosurgery. Interventional MRI-guided DBS lead placement is an emerging technique that can be used to treat ET patients, though the data are limited due to the perceived difficulty of direct targeting the ventral intermediate nucleus (VIM) relative to other structures. Here we review the experience of a single surgeon with interventional MRI-guided DBS targeting of the VIM in ET patients under general anesthesia in a community setting.
METHOD: We conducted a retrospective chart review of ET patients who underwent DBS under general anesthesia using an MRI-guided ClearPoint surgical technique at Willis-Knighton Health System between 2016 and 2021. Demographics, radial error, procedure details, complications, and clinical outcomes were collected. Clinical outcome measures included postoperative medication reduction, the Quality of Life in Essential Tremor Questionnaire (QUEST), and a reduced 19-item version of the Fahn-Tolosa-Marín (FTM) tremor rating scale (upper-limb items from parts A-C; maximum 76 points).
RESULTS: A total of 113 ET patients (50 females [44.2%]; mean age 68.1 ± 9.4) underwent placement of 175 DBS leads. The 2D radial error was 0.43 ± 0.33 mm with only 2 leads requiring more than one pass. Following DBS placement, 69.2% stopped or reduced medication. On the reduced 19-item FTM (maximum 76 points), scores improved from 34.0 preoperatively to 8.9 postoperatively (-76.4%, p < 0.001). The QUEST Summary Index improved from 47.1 preoperatively to 29.4 postoperatively with an average improvement of 77.8%.
CONCLUSION: Interventional MRI-guided DBS lead placement under general anesthesia is a feasible and effective technique for ET patients that may expand the reach of DBS therapy to those with significant anxiety regarding traditional, awake surgery.
METHOD: We conducted a retrospective chart review of ET patients who underwent DBS under general anesthesia using an MRI-guided ClearPoint surgical technique at Willis-Knighton Health System between 2016 and 2021. Demographics, radial error, procedure details, complications, and clinical outcomes were collected. Clinical outcome measures included postoperative medication reduction, the Quality of Life in Essential Tremor Questionnaire (QUEST), and a reduced 19-item version of the Fahn-Tolosa-Marín (FTM) tremor rating scale (upper-limb items from parts A-C; maximum 76 points).
RESULTS: A total of 113 ET patients (50 females [44.2%]; mean age 68.1 ± 9.4) underwent placement of 175 DBS leads. The 2D radial error was 0.43 ± 0.33 mm with only 2 leads requiring more than one pass. Following DBS placement, 69.2% stopped or reduced medication. On the reduced 19-item FTM (maximum 76 points), scores improved from 34.0 preoperatively to 8.9 postoperatively (-76.4%, p < 0.001). The QUEST Summary Index improved from 47.1 preoperatively to 29.4 postoperatively with an average improvement of 77.8%.
CONCLUSION: Interventional MRI-guided DBS lead placement under general anesthesia is a feasible and effective technique for ET patients that may expand the reach of DBS therapy to those with significant anxiety regarding traditional, awake surgery.