Ventralis oralis anterior (Voa) deep brain stimulation plus Gamma Knife thalamotomy in an elderly patient with essential tremor: A case report.
Journal
Medicine
ISSN: 1536-5964
Titre abrégé: Medicine (Baltimore)
Pays: United States
ID NLM: 2985248R
Informations de publication
Date de publication:
16 Apr 2021
16 Apr 2021
Historique:
received:
13
01
2021
accepted:
18
03
2021
entrez:
13
4
2021
pubmed:
14
4
2021
medline:
20
4
2021
Statut:
ppublish
Résumé
Deep brain stimulation (DBS) of the ventralis intermedius nucleus (Vim) provides a safe and effective therapy for medically refractory essential tremor (ET). However, DBS may be risky in elderly patients and those with ischemic brain lesions. Gamma Knife radiosurgery (GKS) is a minimally invasive procedure, but bilateral thalamotomy is dangerous. We report a case of ventralis oralis anterior nucleus (Voa) DBS for dominant hand tremor plus Voa GKS for nondominant hand tremor in a very elderly patient with medically intractable ET. An 83-year-old right-handed woman visited our hospital with a medically intractable ET. Because of the ischemic lesion in the right basal ganglia, we decided to perform left unilateral DBS instead of bilateral DBS. We chose Voa as the target for DBS because, clinically, her tremor was mainly confined to her hands, and Voa had better intraoperative microelectrode recording results than Vim. After 2 years, her right-hand tremor remained in an improved state, but she still had severe tremor in her left hand. Therefore, we performed GKS targeting the right Voa. One year after surgery, the patient's hand tremor successfully improved without any complications. Salvage Voa GKS after unilateral Voa DBS is a valuable option for very elderly patients and patients with ischemic brain lesions. We suggest that Voa GKS thalamotomy is as useful and safe a surgical technique as Vim GKS for dystonic hand tremor. To the best of our knowledge, this is the first case report using salvage Voa as the only target for ET.
Identifiants
pubmed: 33847653
doi: 10.1097/MD.0000000000025461
pii: 00005792-202104160-00049
pmc: PMC8052051
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e25461Subventions
Organisme : Ministry of Education (MOE) and Chungbuk National University Korea National University Development Project
ID : 2020
Informations de copyright
Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors have no conflicts of interests to disclose.
Références
Elias WJ, Shah BB. Tremor. JAMA 2014;311:948–54.
Zesiewicz TA, Elble RJ, Louis ED, et al. Evidence-based guideline update: treatment of essential tremor: report of the quality standards subcommittee of the American Academy of Neurology. Neurology 2011;77:1752–5.
Fasano A, Deuschl G. Therapeutic advances in tremor. Movement Disordersy 2015;30:1557–65.
Petraglia FW 3rd, Farber SH, Han JL, et al. Comparison of bilateral vs staged unilateral deep brain stimulation (DBS) in Parkinson disease in patients under 70 years of age. Neuromodulation 2016;19:31–7.
Okun MS, Foote KD. Parkinson disease DBS: what, when, who and why? The time has come to tailor DBS targets. Exp Rev Neurotherap 2010;10:1847–57.
Toda H, Saiki H, Nishida N, et al. Update on deep brain stimulation for dyskinesia and dystonia: a literature review. Neurologia Medico-Chirurgica 2016;56:236–48.
Loiselle C, Young R. Gamma knife: a useful tool for treatment of essential tremor. Transl Cancer Res 2014;3:338–41.
Alesch F, Pinter MM, Helscher RJ, et al. Stimulation of the ventral intermediate thalamic nucleus in tremor dominated Parkinson disease and essential tremor. Acta Neurochirurgica 1995;136:75–81.
Foote KD, Seignourel P, Fernandez HH, et al. Dual electrode thalamic deep brain stimulation for the treatment of posttraumatic and multiple sclerosis tremor. Neurosurgery 2006;58: (4 Suppl 2): ONS-280-285discussion ONS-285-286.
Berk C, Carr J, Sinden M, et al. Thalamic deep brain stimulation for the treatment of tremor due to multiple sclerosis: a prospective study of tremor and quality of life. J Neurosurg 2002;97:815–20.
Voges J, Hilker R, Botzel K, et al. Thirty days complication rate following surgery performed for deep-brain-stimulation. Movement Disorders 2007;22:1486–9.
Beric A, Kelly PJ, Rezai A, et al. Complications of deep brain stimulation surgery. Stereotactic Funct Neurosurg 2001;77:73–8.
Slowinski JL, Putzke JD, Uitti RJ, et al. Unilateral deep brain stimulation of the subthalamic nucleus for Parkinson disease. J Neurosurg 2007;106:626–32.
Germano IM, Gracies JM, Weisz DJ, et al. Unilateral stimulation of the subthalamic nucleus in Parkinson disease: a double-blind 12-month evaluation study. J Neurosurg 2004;101:36–42.
Papapetropoulos S, Salcedo AG, Singer C, et al. Staged unilateral or bilateral STN-DBS? Mov Disord 2008;23:775.
Higuchi Y, Matsuda S, Serizawa T. Gamma Knife radiosurgery in movement disorders: Indications and limitations. Movement Disorders 2017;32:28–35.
Benito-Leon J, Bermejo-Pareja F, Morales JM, et al. Prevalence of essential tremor in three elderly populations of central Spain. Movement Disorders 2003;18:389–94.
Speelman JD, Schuurman R, de Bie RM, et al. Stereotactic neurosurgery for tremor. Movement Disorders 2002;17: (Suppl 3): S84–8.
Krack P, Dostrovsky J, Ilinsky I, et al. Surgery of the motor thalamus: problems with the present nomenclatures. Movement Disorders 2002;17: (Suppl 3): S2–8.
Goto S, Tsuiki H, Soyama N, et al. Stereotactic selective Vo-complex thalamotomy in a patient with dystonic writer's cramp. Neurology 1997;49:1173–4.
Taira T, Hori T. Stereotactic ventrooralis thalamotomy for task-specific focal hand dystonia (writer's cramp). Stereotactic Funct Neurosurg 2003;80:88–91.
Horisawa S, Taira T, Goto S, et al. Long-term improvement of musician's dystonia after stereotactic ventro-oral thalamotomy. Annals Neurol 2013;74:648–54.
Horisawa S, Tamura N, Hayashi M, et al. Gamma Knife ventro-oral thalamotomy for musician's dystonia. Movement Disorders 2017;32:89–90.
Ghika J, Villemure JG, Miklossy J, et al. Postanoxic generalized dystonia improved by bilateral Voa thalamic deep brain stimulation. Neurology 2002;58:311–3.
Asahi T, Taira T, Ikeda K, et al. Full recovery from drummer's dystonia with foot and arm symptoms after stereotactic ventro-oral thalamotomy: a case report. Acta Neurochirurgica 2018;160:835–8.
Foote KD, Okun MS. Ventralis intermedius plus ventralis oralis anterior and posterior deep brain stimulation for posttraumatic Holmes tremor: two leads may be better than one: technical note. Neurosurgery 2005;56: (2 Suppl): E445discussion E445.
Mehanna R, Machado AG, Oravivattanakul S, et al. Comparing two deep brain stimulation leads to one in refractory tremor. Cerebellum 2014;13:425–32.
Yamamoto T, Katayama Y, Kano T, et al. Deep brain stimulation for the treatment of parkinsonian, essential, and poststroke tremor: a suitable stimulation method and changes in effective stimulation intensity. J Neurosurg 2004;101:201–9.