选择性丘脑腹中间核毁损术治疗震颤型帕金森病

Selective ventralis intermedius nucleus thalamotomy for medically refractory tremor of parkinson's disease patients

目的 探讨选择性丘脑腹中间核 (Vim)毁损术的手术方法及对震颤型帕金森病的疗效 .方法 CT解剖定位 ,微刺激、微记录及放大刺激进行神经电生理校对 ,行小灶性毁损 .手术前后行 UPDRS分项计分、手指拍击实验和行走试验并计算改善率 .结果 33例震颤型帕金森病患者术中完全控制震颤 .UPDRS分项计分、手指拍击实验和行走试验及改善率均显示手术疗效显著 . 2 wk后复发 1例 .轻度构音障碍 1例 .结论 选择性丘脑 Vim毁损术对震颤型帕金森病有显著疗效 .严格掌握手术适应证 ,合理应用微电极技术 。

AIM To discuss the method and the outcome of selective ventralis intermedius nucleus thalamotomy for medically refractory tremor of Parkinson's disease patients. METHODS After anatomical localization with spiral CT and comfirming the target by microstimulation, microrecording and marcostimulation a small lesion was made. Subcomponents of the UPDRS, waking test and taping fingers was given before and after the operation. RESULTS All tremors were controlled in the operation. Subcomponents of the UPDRS, waking test and taping fingers all showed a better out come of the operation. The tremor of a patient had been found again two weeks later. Disarthria was observed in one patient. It remained three months later although improvement was found. CONCLUSION Selective Vim thalamotomy is a better treatment for medically refractory tremor of Parkinsons's disease patients. Indications, technique of microrecording and lesion volume are the basis of success in operation.