title: Mechanical injury of the subthalamic area during stereotactic surgery followed by improvement of trunk, neck, and face tremor--case report--.
abstract: A 50-year-old man had undergone right nucleus ventrointermedius (Vim) thalamotomy 1 year previously, resulting in the disappearance of left hand tremor. However, he presented with right distal and proximal tremor including the axial trunk, neck, and head. Deep brain stimulation (DBS) of the left Vim for these symptoms was unsuccessful. Attempts were made to stimulate the left Vim, nucleus ventralis lateralis, and subthalamic nucleus (STN), but no significant improvement was obtained after repeat surgery. However, subsequent improvement of the symptoms including proximal tremor was very marked even without DBS stimulation. Brain magnetic resonance imaging demonstrated lesion and edema in the posteromedial area of the STN. Mechanical injury of the area caused by the surgical procedures may have contributed to the improvement in his persistent symptoms.
authors.affiliation: Department of Neurosurgery, Toyama Medical and Pharmaceutical University, Toyama, Japan. yhira@ms.toyama-mpu.ac.jp
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hirashima
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ikeda
authors.forename: Takashi
authors.initials: T
authors.lastname: Asahi
authors.forename: Takashi
authors.initials: T
authors.lastname: Shibata
authors.forename: Kyo
authors.initials: K
authors.lastname: Noguchi
authors.forename: Fumio
authors.initials: F
authors.lastname: Shima
authors.forename: Shunro
authors.initials: S
authors.lastname: Endo
mesh_terms: D004599:Electric Stimulation Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D013238:Stereotaxic Techniques / Q000009:adverse effects*; D020531:Subthalamic Nucleus / Q000293:injuries*; D013788:Thalamus / Q000601:surgery*; D016896:Treatment Outcome; D014202:Tremor / Q000503:physiopathology* / Q000601:surgery* / Q000628:therapy; D014947:Wounds and Injuries / Q000209:etiology