微电极导向腹后内侧苍白球毁损治疗帕金森病

Microelectrode guided posteroventral medial pallidotomy for Parkinson′s disease

目的 探讨微电极导向腹后内侧苍白球毁损手术治疗帕金森病的方法、效果与评价。 方法 通过微电极细胞电生理记录技术对 Ｃ Ｔ 定位靶点进行分析、确认和调整，对１０９ 例帕金森病患者分别行单侧腹后内侧苍白球毁损术（４５ 例） 、同期双侧腹后内侧苍白球毁损术（２１ 例） 、同期腹后内侧苍白球和丘脑 Ｖｉｍ 核联合毁损术（４３ 例） 。患者术前及术后不同状态行改良 Ｗｅｂｓｔｅｒ 法记分，分别计算改善率，并进行疗效评估。 结果 经微电极确认后的电生理靶点与 Ｃ Ｔ定位靶点存在明显差异，靶点调整率８４７ ％ ，手术有效率１００ ％ ，术后开状态改善率（７２７ ±１１３） ％ ，关状态改善率（８９３±８１） ％ 。近期并发症为３７ ％ ，无永久性并发症。 结论 微电极记录技术能显著提高手术定位准确率及成功率，同期双侧腹后内侧苍白球毁损术及腹后内侧苍白球和丘脑 Ｖｉｍ 核联合毁损术可一次性消除或缓解患者全部症状，具有明显临床治疗优势。

Objective To introduce the methods and effects of microelectrode guided posteroventral pallidotomy(PVP) for Parkinson′s disease. Methods 109 patients underwent PVP by microelectrode electrophysiological recording for intraoperative target localization. 45 patients underwent unilateral PVP, 21 patients simultaneous bilateral PVP, 43 patients combined thalamotomy and PVP. Modified Webster Scale was used for objective assessments before and after operation. Postoperative CT scan or MRI was performed to localise lesions. Results Microelectrode recording usually led to a final pallidotomy lesion position that deviated from the CT stereotactically defined target point. The change rate of targets was 84 7%. PVP significantly and immediately improved all Parkinsonian motor signs and reduced drug induced motor fluctuations and dyskinesia. The mean Webster Scale was improved by (72 7±11 3)% in the “on” state, and (89 3±8 1)% in the “off” state.No patient showed permanent complications. Conclusions Microelectrode guided PVP was proved to be safe and effective. Bilateral PVP and combined PVP can significantly and immediately abolish all Parkinsonian motor signs. Physiological methods of microelectrode recording can significantly improve the safety and efficacy of PVP, and decrease the rate of complication.