Caudal Zona Incerta/VOP Radiofrequency Lesioning Guided by Combined Stereotactic MRI and Microelectrode Recording for Posttraumatic Midbrain Resting-Kinetic Tremor

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• 作者：William Omar Contreras Lopez ; Angelo R. Azevedo ; Rubens G. Cury ; Francisco Alencar ; Iuri S. Neville ; Paul R. Reis ; Jessie Navarro ; Bernardo Monaco ; Fabio E. Fernandes da Silva ; Manoel J. Teixeira ; Erich T. Fonoff ; ^{erich.fonoff@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Ablative radiofrequency surgery ; Deep brain stimulation ; Diffuse axonal injury ; Forel's fields ; Microelectrode recording ; Traumatic brain injury ; Tremor ; Zona incerta
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：86
• 期：Complete
• 页码：316-320
• 全文大小：1227 K

文摘

Reporting the outcome of two patients who underwent unilateral ablative stereotactic surgery to treat pharmacologic resistant posttraumatic tremor (PTT).

Methods

We present two patients (31 and 47 years old) with refractory PTT severely affecting their quality of life. Under stereotactic guidance, refined by T2-weighted magnetic resonance imaging and double-channel multiunit microelectrode recording (MER), three sequential radiofrequency lesions were performed in the caudal zona incerta (cZi) up to the base of thalamus (VOP). Effects of cZi/VOP lesion were prospectively rated with a tremor rating scale.

Results

Both patients demonstrated intraoperative tremor suppression with sustained results up to 18 months follow-up, with improvement of 92% and 84%, respectively, on the tremor rating scale. Tremor improvement was associated with enhancement functionality and quality of life for the patients. The patients returned to their work after the procedure. No adverse effects were observed up to the last follow-up.

Conclusion

Radiofrequency lesion of the cZi/VOP target was effective for posttraumatic tremor in both cases. The use of T2-weighted images and MER was found helpful in increasing the precision and safety of the procedure, because it leads the RF probe by relying on neighbor structures based on thalamus and subthalamic nucleus.