チエルノフ　ミハイル    Department   School of Medicine(Tokyo Women's Medical University Adachi Medical Center), School of Medicine    Position   Assistant Professor
Language	English
Title	Gamma Knife thalamotomy based on the strategy of stereotactic thermocoagulation.
Conference	ISRS2017 Congress
Conference Type	International society and overseas society
Presentation Type	Poster notice
Lecture Type	General
Publisher and common publisher	◎TAMURA Noriko, HORISAWA Shiro, HANADA,Tomoko HANADA,Tomoko , HAYASHI Motohiro, TAMURA Manabu, CHERNOV Mikhail, TAIRA Takaomi, KAWAMATA Takakazu
Date	2017/05/28
Venue (city and name of the country)	Montreux, Switzerland
Society abstract	ISRS2017 Program 049
Summary	Objective: To evaluate the safety and efficacy of unilateral Gamma Knife (GK) thalamotomy for treatment of severe tremor with a retrospective assessment in our Institute.Methods: From October 2014 till September 2016, 24 patients (mean age, 78 years; 13 men; mean duration of symptoms, 25.8 years) with severe drug-resistant tremor (21 essential, 1 dystonian, 1 post-thalamic hemorrhage, 1 parkinsonian) were treated with unilateral GK (all on left side) targeting the ventral intermediate nucleus (VIM) with single shot through a 4-mm collimator. Beam blocking technique was used in 4 patients. Neurosurgeon initially selected the target in the same way as with usual thermo-coagulation, then discussed the modification to the final target with GK surgeon. The maximum dose was 130 Gy. Neurologic and neuropsychological assessments were performed by an independent neurosurgeon before treatment and at 12 months thereafter. MRI follow-up was achieved at 1, 3, 6, and 12 months. Upper limb severity of the tremor in 14 patients with less than 12 month follow-up was statistically analyzed by the modified TETRAS (the essential tremor rating assessment scale).Results: The upper limb every tremor sub-score, writing sub-score and circle drawing sub-score (0-4) was significantly improved (p=0.001, 0.001 and 0005 respectively according to Wilcoxon test). Tremor score was improved by 1 to 12 months (mean period, 5.5 months) after GK, while 2 patients had no effect after GK. The only side effect was a hemiparesis associated with excessive edema around the thalamotomy in one patient.Conclusion: The well-discussed target decision with the strategy for GKT is a safe and efficient treatment for severe medically refractory tremor.