伽玛刀丘脑腹中间核、腹嘴核毁损术治疗帕金森病及其他运动异常(附58例临床报道)

Gamma knife thalamotomy for the treatment of Parkinson disease and other movement disorders

目的总结采用伽玛刀毁损丘脑腹中间核(ventrointermediatenucleus,Vim)、腹嘴核(ventrooralnucleus,VO)治疗58例帕金森病(parkinsondisense,PD)及其他运动异常性疾患,分析治疗后的临床变化过程及丘脑毁损灶的变化。方法采用4mm准直器单枪对靶点照射130Gy。参照微电极验证立体定向丘脑毁损术时确定靶点的方法确定靶点。结果随访2年以上的患者有40例,最长的患者随访了9年。在MRI上,丘脑毁损灶的变化可分为大而不规则形和小圆形,其容积在数10mm3到约600mm3。80%的患者效果良好而无明显并发症,震颤在治疗1年后减弱。如果震颤持续存在,则追加微电极验证的常规立体定向丘脑毁损术。结论伽玛刀丘脑毁损术治疗运动异常疗效明显。

Objective The treatment of Parkinson disease and other kinds of involuntary movement by gamma knife is presented. The clinical course and thalamic lesions were examined. Methods The course and results for the whole series of 58 patients were examined. Treatment was undertaken using a single 4 -mm collimator shot to deliver 130 Gy to the target. Results Forty patients have been followed for more than 2 years and the longest one was 9 years. Volumetric analysis on MR imaging revealed that the volume of the lesions ranging from smaller than 100mm^3 to more than 500mm^3, and gradually decreased in size. Eighty percent of the treated cases showed good results and no significant complications. If tremor persisted, conventional stereotacticthalamotomy with microrecording was performed. Conclusion Gamma thalamotomy for functional disorders is still under development, but the results with careful target planning are satisfactory. There are grounds for increasing optimism.