Julia M Mueller, Lucinda T Chiu, Fiona Lynn, Rachel G Lewis, Shama Patel, Matthew Wodziak, Neepa Patel, Sepehr Sani
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Patient demographics, intra-procedural treatment parameters, peri-procedural adverse events, and 3-month Clinical Rating Scale for Tremor Part B (CRST-B) scores were compared to MRgFUS studies that utilized varying degrees of anesthesia.\n\n\nRESULTS\nThere were no anesthesia related adverse events or unsuccessful treatments. There were no early treatment terminations due to patient discomfort, regardless of skull density ratio. 94.6% of patients would repeat the procedure again. The most common side effects during treatment were facial/tongue paresthesia (26.3%), followed by nausea (22.3%), dysarthria (8.6%), and scalp pain (8.0%). No anxiolytic, pain, or antihypertensive medications were administered. The most common early adverse event after MRgFUS procedure was gait imbalance (58.3%). 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引用次数: 0
摘要
引言磁共振引导下聚焦超声(MRgFUS)是治疗本质性震颤(ET)和震颤为主的帕金森病(TDPD)的有效方法,通常在镇静或麻醉师在场的情况下进行,以尽量减少不良反应并最大限度地提高患者的舒适度。本研究探讨了在没有麻醉师在场的情况下进行 MRgFUS 的安全性、可行性和耐受性。方法这是一项单一学术中心的回顾性研究,研究对象是在没有麻醉师支持的情况下接受 MRgFUS 治疗的 180 例 ET 和 TDPD 患者。将患者的人口统计学特征、术中治疗参数、围术期不良事件以及 3 个月的震颤临床分级表 B 部分(CRST-B)评分与使用不同程度麻醉的 MRgFUS 研究进行了比较。无论颅骨密度比率如何,均未出现因患者不适而提前终止治疗的情况。94.6%的患者愿意再次接受治疗。治疗过程中最常见的副作用是面部/舌头麻痹(26.3%),其次是恶心(22.3%)、构音障碍(8.6%)和头皮疼痛(8.0%)。没有使用抗焦虑、止痛或降压药物。MRgFUS手术后最常见的早期不良反应是步态失衡(58.3%)。结论MRgFUS无需术中麻醉师支持,是一种安全、可行且耐受性良好的选择,不会增加围术期不良事件。
Magnetic Resonance-Guided Focused Ultrasound without Anesthesiologist Support.
INTRODUCTION
Magnetic resonance-guided focused ultrasound (MRgFUS) is an effective treatment option for essential tremor (ET) and tremor dominant Parkinson's disease (TDPD), which is often performed with sedation or in the presence of an anesthesiologist in an effort to minimize adverse events and maximize patient comfort. This study explores the safety, feasibility, and tolerability of performing MRgFUS without an anesthesiologist.
METHODS
This is a single academic center, retrospective review of 180 ET and TDPD patients who underwent MRgFUS treatment without anesthesiologist support. Patient demographics, intra-procedural treatment parameters, peri-procedural adverse events, and 3-month Clinical Rating Scale for Tremor Part B (CRST-B) scores were compared to MRgFUS studies that utilized varying degrees of anesthesia.
RESULTS
There were no anesthesia related adverse events or unsuccessful treatments. There were no early treatment terminations due to patient discomfort, regardless of skull density ratio. 94.6% of patients would repeat the procedure again. The most common side effects during treatment were facial/tongue paresthesia (26.3%), followed by nausea (22.3%), dysarthria (8.6%), and scalp pain (8.0%). No anxiolytic, pain, or antihypertensive medications were administered. The most common early adverse event after MRgFUS procedure was gait imbalance (58.3%). There was a significant reduction of 83.1% (83.4% ET and 80.5% TDPD) of the mean CRST-B scores of the treated hand when comparing 3-month and baseline scores (1.8 vs. 10.9, n = 109, p < 0.0001).
CONCLUSION
MRgFUS without intra-procedural anesthesiologist support is a safe, feasible, and well-tolerated option, without an increase in peri-procedural adverse events.
期刊介绍:
''Stereotactic and Functional Neurosurgery'' provides a single source for the reader to keep abreast of developments in the most rapidly advancing subspecialty within neurosurgery. Technological advances in computer-assisted surgery, robotics, imaging and neurophysiology are being applied to clinical problems with ever-increasing rapidity in stereotaxis more than any other field, providing opportunities for new approaches to surgical and radiotherapeutic management of diseases of the brain, spinal cord, and spine. Issues feature advances in the use of deep-brain stimulation, imaging-guided techniques in stereotactic biopsy and craniotomy, stereotactic radiosurgery, and stereotactically implanted and guided radiotherapeutics and biologicals in the treatment of functional and movement disorders, brain tumors, and other diseases of the brain. Background information from basic science laboratories related to such clinical advances provides the reader with an overall perspective of this field. Proceedings and abstracts from many of the key international meetings furnish an overview of this specialty available nowhere else. ''Stereotactic and Functional Neurosurgery'' meets the information needs of both investigators and clinicians in this rapidly advancing field.