Bilateral Thalamic Surgery:Is It Safe and Effective to Combine Lesioning and DBS for Intractable Tremor

摘要

Deep brain stimulation (DBS) of ventral intermediate (VIM) nucleus is an effective treatment for limb tremor accompanying Parkinson disease (PD), essential tremor (ET) and multiple sclerosis (MS). Stere-otactic surgery is regarded as an effective treatment for tremor. Unilateral thalamotomies have an extremely good outcome for tremor control .Bilateral thalamotomies can be performed but are discouraged because of their association with increased risk of postoperative dysar-thria, disequilibrium and cognitive deficits . Some patients require bilateral thalamic surgery to control axial tremor or bilateral extremity tremor. Although bilateral DBS is currently advocated for these patients, in certain countries it would be cost effective and medically effective if one could safely carry out thalamotomy on one side and DBS on the other side . The present study addresses this issue via a retrospective study of thalamic surgery carried out in a single institution by a single surgeon for tremor.