Vim和Vo核为毁损靶点的丘脑切开术治疗帕金森病及其他不随意运动障碍

Thalamotomy with Vim and Vo as Targets for PD and Other Movement Disorders

目的 讨论以丘脑腹中间核 (Vim)和丘脑腹嘴核 (Vo)为毁损靶点的丘脑切开术治疗帕金森病及其他不随意运动障碍的方法和原理。方法 收治 17例帕金森病及其他不随意运动异常症 ,其中以震颤为主要症状者以Vim丘脑切开术 (Vimthatamotomy)治疗。震颤伴僵直及肌张力障碍者 ,以Vo Vim丘脑切开术 (Vo Vimthatamotomy)治疗。以临床观察和表面肌电图对手术效果进行评价。结果 全部病例术后不随意运动障碍立即完全消失。随访 2～ 18个月 ,仅 1例术后 2周震颤复发。结论 Vim丘脑切开术治疗以震颤为代表的运动亢进的不随运动障碍疗效确切。Vo Vim丘脑切开术治疗肌强直为代表的肌张力增高的不随运动障碍疗效确切。

Objective To discuss the thalamotomy with Vim and Vo as targets for Parkinson's disease and other movement disorders. Methods Using the thalamotomy with microrecording, 17 cases with movement disorders were treated between 2002 and 2004. They were 9cases of PD, and 4 cases of essential tremor, 4 cases of distonia. The patients with tremor as a major manifestation underwent the thalamotomy with Vim as target, the patients with rigidity as a major manifestation underwent the thalamotomy with Vo and Vim as targets. Results In all of the cases ,the tremor and rigidity were abolished or reduced to a considerable extent without remarkable complications. During a 2 18months follow up, only a female patient whose tremor recurred.2 weeks after her operation.Conclusion Practically the effect of Vim thalamotomy is more marked in cases with tremor type movement disorders, Vo Vim thalamotomy is more marked in cases with rigidity type cases.