雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Brain and Nerve No to Shinkei Volume 37, Issue 6 （June 1985）

Brain and Nerve 脳と神経 37巻6号（1985年6月発行）

Japanese English

原著

最小凝固巣による選択的視床（Vim）手術効果の長期追跡調査 LONG-TERM FOLLOW-UP STUDY OF SELECTIVE VIM-THALAMOTOMY 永関慶重 ^1,2 , 柴崎徹 ¹ , 平井達夫 ¹ , 川島康宏 ¹ , 平戸政史 ¹ , 和田裕千代 ¹ , 宮崎瑞穂 ¹ , 大江千廣 ¹ Yoshishige Nagaseki ^1,2 , Tohru Shibazaki ¹ , Tatsuo Hirai ¹ , Yasuhiro Kawashima ¹ , Masafumi Hirato ¹ , Hirochiyo Wada ¹ , Mizuho Miyazaki ¹ , Chihiro Ohye ¹ ¹群馬大学脳神経外科 ²Department of Neurosurgery Yamanashi Medical College ¹Department of Neurosurgery, Gunma University pp.545-554

発行日 1985年6月1日 Published Date 1985/6/1

DOI https://doi.org/10.11477/mf.1406205522

PDF(6429KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside

　抄録　定位的選択的視床手術法により最小凝固巣（約40〜60mm³）で寛解をみた振戦症例の長期追跡調査（最長7年，平均3.6年）を行った。振戦を主体とするパーキンソン病（PA）26症例，本態性振戦（ESS—T）16症例が対象で計49回（両側4例，再手術3例）の手術を行った。Leksel1の装置を用いて微小電極法によりX線学的および電気生理学的に視床Vim核を決定し2本の凝固用電極（長さ4mm間隔3mm）を用いて半径3mmの円柱内で振戦がとまるまで凝固巣を追加した。この凝固巣をその体積により2群（I群：1／4円柱内1〜3unit lesions,II群：1／2〜1円柱内3〜5 unit lesions）に分類し，予術結果は術後14日目の早期（Early results）と追跡調査時点（Late results）で評価した。最小凝固通巣はI群に相当しPA 1O／13例，ESS-T 6／11例は早期に全寛解を認め，　Late resultsでもその効果は持続し極く軽度の残存例も含めると100％の寛解維持率であった。II群ではPA14／15例，ESS-T 7／7例でほぼ完全な持続的寛解を示した。術後合併症は感覚障害1例，構音障害1例が残存していたのみである。結語：振戦に対する最小凝固による選択的視床手術は長期追跡調査にても効果の持続の点で満足すべきものであり，振戦が再燃した場合は術後14日以内でそれ以後の増強は認めなかった。

To evaluate the effect of the physiologically defined selective Vim-thalamotomy on tremor type Parkinson's disease (PA, 26 cases) and essential tremor (ESS-T, 16 cases), a long-term follow-up study was conducted. The follow-up time extended from 4 months to 7 years (mean: 3.6 years). On 42 cases a total of 49 operations (4 bilateral sur-gery and 3 reoperations) were carried out. After identifying kinesthetic neuron, the coagulative lesion was made by using Leksell's apparatus between two needles of 4 mm effective tip length located with 3 mm interval including the record-ing point. One coagulation (unit lesion) destroyed about 20mm³ brain tissue taking account of the mechanical damage by the needles themselves. The unit lesion was added around an imaginary cylinder of 3mm radius, until the tremor was abolished completely. On the basis of number of unit lesion and its extent within an imaginary cylinder, these 49 operations were divided into the following group. Group I (minimal lesion group): coagulative lesion of 1 to 3 units within a quadrant of the imaginary cylinder. Group II: 3 to 5 units within 1/2 to one cylinder. The early (14 days after operation) and the late results on the tremor were evaluated clinically and elect-romyographically by 4 different categories: com-plete abolition, slight residual, residual, and recur-rence in a strict sense. The late results in 13 PA cases of group I (similar to the early results) were: 10 complete abolition, 2 slight residual and one recurred, this case was reoperated 3 months after first operation and therefore categolized in group II. The late results in 11 ESS-T cases of group I were: 6 complete arrest, 4 slight residual, and one recurred case, which had been reoperated 2 years after operation. Therefore in a total of 24 minimal lesioned cases with PA and ESS-T com-plete abolition in 16, slight residual in 6, and 2 reoperated cases. In these successful 22 cases with minimal lesion, the tremor was abolished without noticeable long-lasting side effect. In other 20 cases with PA and ESS-T of group II, the tremor was almost completely relieved and maintained. In conclusion, by radiographically and physiolo-gically controlled selective Vim thalamotomy for Parkinsonian and essential tremor, it was shown that the effect of minimal lesion was valid and well maintained on the long-term follow-up base.