ムラガキ　ヨシヒロ   MURAGAKI Yoshihiro   村垣　善浩    所属   医学部 医学科（東京女子医科大学病院）    職種   客員教授
言語種別	英語
発表タイトル	Gamma Knife thalamotomy based on the strategy of stereotactic thermocoagulation.
会議名	ISRS2017 Congress
学会区分	国際学会及び海外の学会
発表形式	ポスター掲示
講演区分	一般
発表者・共同発表者	◎TAMURA Noriko, HORISAWA Shiro, HANADA,Tomoko HANADA,Tomoko , HAYASHI Motohiro, TAMURA Manabu, CHERNOV Mikhail, TAIRA Takaomi, KAWAMATA Takakazu
発表年月日	2017/05/28
開催地 （都市, 国名）	Montreux, Switzerland
学会抄録	ISRS2017 Program 049
概要	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.