Objective:To investigate the clinical effect of deep brain stimulation (DBS) of the globus pallidus internus (GPi-DBS) for the treatment of primary cervical dystonia.Methods:The clinical data of 14 patients with cervical dystonia treated with GPi-DBS in the Neurosurgery Department of the Second Affiliated Hospital of Air Force Medical University from October 2014 to April 2019 were retrospectively analyzed. The device of DBS was turned on at 1 month after the operation, and all patients were followed up in outpatient clinics at 1, 3, 6 months, 1 year and every year thereafter. Follow-up contents included: observation of hardware-related complications; the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) [including: Torticollis Severity Scale (TSS), Disability Scale (DS) and Pain Scale (PS)] score to assess the improvement of the patient′s symptoms. The calculation formula of improvement rate was: (preoperative score-postoperative score)/preoperative score×100%, of which ≤30% was regarded as mild improvement, >30%-60% as moderate improvement, and >60% was significant improvement.Results:All 14 patients underwent successful operations, and there were no postoperative complications such as intracranial hemorrhage and infection. A total of 28 electrodes were implanted (on 28 sides), of which the monopolar stimulation mode was applied in 13 electrodes, and the double-monopolar (two cathodes) stimulation mode in 15 electrodes. The follow-up time of 14 patients was 33.7±12.4 months (12-53 months) after the DBS device was turned on. During the follow-up period, 2 patients developed dyskinesia in the lower extremities, and the symptoms were improved by adjusting the stimulation parameters. With the extension of follow-up time, TSS, DS and PS scores all showed a decreasing trend (all P<0.001); torticollis symptoms, disability and pain symptoms were significantly improved 3 months after the device was turned on. At the last follow-up, there was no statistically significant difference in the TSS, DS or PS scores compared with the patients′ conditions at 1 year after the device was turned on (all P>0.05). At the last follow-up, the TSS scores of 14 patients were as follows: 1 case was mildly improved, 6 cases were moderately improved, and 7 cases were significantly improved. In the DS score results, 2 cases were mildly improved, 2 cases were moderately improved, and 10 cases were significantly improved. In the PS results, 14 cases were significantly improved. Conclusion:GPi-DBS treatment of primary cervical dystonia has fewer complications, significant improvement in torticollis and pain symptoms, and prolonged effect.

Objective: To evaluate the long-term efficacy of subthalamic nucleus deep brain stimulation (STN-DBS) in the treatment of isolated dystonia, and explore the factors influencing the results. Methods: The clinical data of 23 consecutive patients with isolated dystonia treated with STN-DBS in the Department of Neurosurgery, Tangdu Hospital, Air Force Military Medical University from December 2004 to December 2014,were retrospectively analyzed. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used to quantify the dystonia symptoms and signs. Multiple linear regression analysis was used to explore the influencing factors of the results. Results: The age of the 23 patients including 8 females and 15 males was 19(10, 27) years old. The follow-up time was 5-12 years, with an average of (8.1±1.8) years.Compared with the preoperative period, the BFMDRS movement score decreased by 30.1 [95% confidence interval (CI): 12.3-47.8)] points, 34.7 (95%CI: 17.0-52.4) points, 34.1 (95%CI: 16.4-51.8) points and 34.0 (95%CI: 16.3-51.7) points (all P<0.001) respectively at 1 year, 3 years, 5 years after surgery and the last follow-up, the average improvement rates were (56.0±20.2)%, (65.3±24.0)%, (64.4±25.1)% and (64.3±25.1)%;the disability score decreased by 6.9 (95%CI: 1.4-12.3)points, 8.7 (95%CI: 3.3-14.2)points, 9.0 (95%CI: 3.6-14.5)points, and 9.2 (95%CI: 3.7-14.7) points (all P<0.001), the average improvement rates were (42.9±17.1)%, (55.5±23.2)%, (57.8±24.8)% and (58.7±24.8)%. Patients with DYT1-positive dystonia had higher rates of improvement in movement and disability scores than patients with DYT1-negative, but there was no statistically significant difference. Multiple linear regression analysis showed that gender, age at onset, course of disease, preoperative movement or disability score had no linear relationship with long-term results (improvement rate of movement or disability score) (both P>0.05). Conclusions: STN-DBS is effective and long-lasting in the treatment of isolated dystonia, but no reliable predictor has been found.

目的 探讨颅盖部巨大骨纤维异常增殖症合并大面积脑梗死开颅去骨瓣减压术的方式.方法 回顾性分析1例颅盖部巨大骨纤维异常增殖症合并左侧额颞顶叶急性大面积脑梗死,行开颅去骨瓣减压术患者的临床资料;并对相关文献进行复习.结果 患者表现意识障碍(昏睡状态)、右侧偏瘫,病情进行性加重;头颅CT示左侧额颞顶叶大面积脑梗死,局部颅骨增厚、骨质密度异常.即行开颅去骨瓣减压术,术中先采用电钻和手摇钻减低骨窗边缘异常增厚的颅骨厚度,再在个别部位将颅骨钻透并用椎板咬骨钳暴露出部分硬脑膜,最后用铣刀沿钻薄的颅骨完整铣除骨瓣.患者术后意识逐渐恢复正常.结论 本例患者的手术方法对颅盖部巨大骨纤维异常增殖症合并其他脑部疾病需行开颅手术的患者也是可行的.先沿其边缘减低异常颅骨的厚度再铣除骨瓣是相对快捷和安全的开颅手术方法.

目的 分析静脉压迫所导致三叉神经痛(TN)的术前影像学评估和显微血管减压术中责任静脉的处理.方法 回顾分析空军军医大学唐都医院神经外科自2017年12月至2018年12月收治的15例存在静脉压迫的TN患者的临床资料,分析术前影像学评估及术中处理.结果 所有患者均通过术前3D-TOF及3D-FIESTA检查,判断责任血管为单纯静脉型或动脉及静脉共同作用型,其中单纯静脉型11例,动脉及静脉共同作用型4例.通过术中分析,符合术前判断.所有患者静脉均得到有效保留,手术疗效满意.结论 通过术前影像学评估能有效预判TN的责任血管,从而指导术中操作.针对静脉压迫型TN,术中应尽量保护静脉,避免因损伤静脉所导致的术后并发症.

Objective To evaluate the long-term efficacy of deep brain stimulation (DBS) in treatment of medically refractory primary generalized dystonia (PGD) and to compare the effect of stimulation of subthalamic nucleus (STN) with that of globus pallidus internus (GPi) in the treatment of dystonia.Methods Twenty-one cases of PGD underwent STN-DBS or GPi-DBS at Department of Neurosurgery,Tangdu Hospital,the Fourth Military Medical University from December 2004 to April 2013 and were enrolled into this study.Among them,11 patients underwent STN stimulation (STN-DBS group) and the other 10 cases received GPi stimulation (GPi-DBS group).Pre-and postoperative severity of dystonia were assessed by using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS).Results The average improvement rates of BFMDRS movement subscale in the 21 cases of PGD were 63.7 ± 14.2 ％ and 66.5 ± 13.7 ％ at 1 and 3 years post operation,respectively.Meanwhile,the disability scores were reduced by 43.7 ± 13.8 ％ and 49.1 ± 12.4 ％,respectively.The movement scores in STN-DBS group were 56.9 ± 20.9 prior to surgery and 18.3 ± 6.8 at 3 years post operation,and the average improvement rate was 64.6 ± 15.2 ％.Their disability scores were 20.0(11.0) prior to surgery.and 8.0(4.0) points at 3 years post operation,and the average improvement rate was 54.5 ％ (15.0 ％).In the GPi-DBS group,the movement scores were 60.8 ± 19.3 before surgery and 18.3 ±7.9 at 3 years post surgery,and the average improvement rate was 68.6 ± 12.5 ％.Their disability scores were 17.5 ±5.4 before surgery and 8.9 ±2.5 post surgery,and the average improvement rate was 47.2 ± 12.8 ％.There was no statistically significant difference in the improvement rates of BFMDRS movement and disability scores between 2 targets at 1 year and 3 years after surgery (both P ＞ 0.05).Conclusions The effect of DBS in the treatment of medically refractory seems to be significant and sustained.Our preliminary results suggest that there is no significant difference in the long-term efficacy between stimulation of STN and stimulation of GPi for dystonia.