摘要目的:探讨经颅磁共振引导聚焦超声(tcMRgFUS)治疗特发性震颤(ET)的临床疗效及安全性。方法:回顾性分析2022年9月至2023年6月香港大学深圳医院神经医学中心神经外科行tcMRgFUS治疗的12例ET患者的临床资料。患者年龄为(53.9±14.8)岁(26～70岁)；病程为(26.2±15.6)年(6～50年)。术前右手震颤临床评定量表(CRST)[ M( Q1， Q3)]评分为15.0(11.3, 22.3)分，ET生活质量问卷(QUEST)评分为46.5(31.3, 65.5)分。术前评估有效颅骨面积、颅骨密度比(SDR)以及有效阵元数量；采用Spearman相关性分析评估有效颅骨面积与有效阵元数量的相关性。12例患者均选择左侧丘脑腹中间核作为治疗靶点，在MR热成像监测下，预设焦斑温度为40～45 ℃以校准位置，45～50 ℃确认有效性和安全性，50～60 ℃消融毁损，时长为15～30 s。观察并记录手术相关并发症。于术后第1天、1个月、3个月评估CRST评分并复查头颅MR；术后1、3个月评价QUEST评分；并计算两种评分的改善率。 结果:12例患者的有效颅骨面积[(362±22)cm 2]与有效阵元数量[ M( Q1， Q3)为948(927，978)个]呈正相关关系( r＝0.63， P＝0.029)；SDR值为0.46±0.13。12例患者的手术均顺利完成，消融温度为(57.5±2.5)℃。震颤症状的治疗有效比例为12/12。12例患者术后1 d MR显示毁损灶和周围水肿带的中心点与计划靶点精准吻合，位置无偏差。其中7例患者共出现15例次轻度不良事件，除1例患者的味觉改变和口角麻木未改善，其余患者症状均在术后1个月内缓解。12例患者的随访时间为3个月。与术前比较，术后1 d[ M( Q1， Q3)为1.5(0，2.0)分]、1个月[2.0(0，2.0)分]、3个月[2.0(1.0，2.0)分]CRST评分的差异具有统计学意义( χ2＝27.87, P<0.001)；改善率分别为(90.8±8.7)%，(85.8±15.8)%和(77.5±21.6)%。与术前比较，术后1个月[21.5(12.5，43.5)分]、3个月[16.5(6.5，34.3)分]QUEST评分的差异具有统计学意义( χ2＝20.47, P<0.001)；改善率分别为(49.5±29.0)%、(58.0±25.8)%。12例患者术后规律随访头颅MR，可见异常信号逐渐缩小，提示水肿带逐渐吸收，毁损灶直径也逐渐缩小。 结论:tcMRgFUS治疗ET可改善患者的震颤症状，手术相关并发症通常在术后1个月内缓解，该技术较为安全、有效。

abstractsObjective:To explore the clinical efficacy and safety of transcranial magnetic resonance-guided focused ultrasound (tcMRgFUS) in the treatment of essential tremor (ET).Methods:The clinical data of 12 ET patients who underwent tcMRgFUS treatment at the Department of Neurosurgery, Neuromedicine Center, the University of Hong Kong-Shenzhen Hospital from September 2022 to June 2023 were retrospectively analyzed. The patient′s age was 53.9±14.8 years (26-70 years); the disease duration was 26.2±15.6 years (6-50 years). The preoperative Clinical Rating Scale for Tremor (CRST) score of right hand[ M( Q1, Q3)] was 15.0 (11.3, 22.3) points, and the Quality of Life in Essential Tremor Questionnaire (QUEST) score was 46.5 (31.3, 65.5) points. The effective skull area, skull density ratio (SDR), and the number of effective elements were evaluated before surgery; Spearman correlation analysis was used to evaluate the correlation between the skull area and the number of effective elements. All 12 patients had the ventral intermediate nucleus of the thalamus as the treatment target. Under MR thermal imaging monitoring, the preset focal spot temperature was 40 ℃to 45 ℃ to align the target location and size, 45 ℃ to 50 ℃ to verify effectiveness and safety, and 50 ℃ to 60 ℃ for ablation with a duration of 15-30 s. We observed and documented surgery-related complications. CRST was evaluated and head MR was reviewed on the 1st day, 1 month, and 3 months after operation; QUEST was evaluated at 1 and 3 months after operation; and the improvement rate of the two scores was calculated. Results:There was a positive correlation between the effective skull area (362±22 cm 2) and the number of effective elements [ M( Q1, Q3): 948 (927, 978)] in 12 patients ( r=0.63, P=0.029). The SDR value was 0.46±0.13. The operations were all completed successfully. The ablation temperature of 12 patients was (57.5±2.5)°C. The effective rate of treatment of tremor symptoms was 12/12. MR of 12 patients showed damaged lesions and surrounding edema 1 d after surgery. The center point of the edema region accurately matched the planned target point, and there was no deviation in position. A total of 15 mild adverse events occurred in 7 patients. Except for 1 patient whose taste change and numbness at the corners of the mouth did not improve, the symptoms of the other patients were relieved within 1 month after surgery. The follow-up time of 12 patients was 3 months. Compared with pre-operation, the CRST scores at 1 day after operation [ M( Q1, Q3): 1.5 (0, 2.0) points], 1 month post operation [2.0 (0, 2.0) points], and 3 months post operations [2.0 (1.0, 2.0) points] were significantly different ( χ2=27.87, P<0.001); the improvement rates were (90.8±8.7)%, (85.8±15.8)% and (77.5±21.6)% respectively. Compared with those before surgery, the difference in QUEST scores at 1 month [21.5 (12.5, 43.5) points] and 3 months [16.5 (6.5, 34.3) points] after surgery were statistically significant ( χ2=20.47, P<0.001). The improvement rates were (49.5±29.0)% and (58.0±25.8)% respectively. All 12 patients underwent regular follow-up cranial MR after surgery, and it was found that the abnormal signals gradually shrank, indicating that the edema zone was gradually absorbed, and the diameter of the damaged lesions also gradually shrank. Conclusions:The approach of tcMRgFUS can improve patients′ tremor symptoms when treating ET. Surgery-related complications usually resolve within 1 month after surgery. The technology is relatively safe and effective.