微电极引导立体定向手术改善老龄帕金森病患者静止性震颤、僵直及运动迟缓的效果分析

Management of aging patients with Parkinson diseases treated with microelectrode-guided stereotactic pallidotomy and thalamotomy

目的介绍微电极引导立体定向手术治疗老龄帕金森病(PD)改善静止性震颤、僵直、运动迟缓的方法和结果。方法采用立体定向手术,术中行微电极记录技术靶点监测,对28例70岁以上老龄PD患者行丘脑腹外侧核(VL)、苍白球腹后内侧部(Gpi)射频毁损,其中2例A型(震颤型)患者行单侧VL毁损术,1例A型患者行双侧VL毁损术;26例行Gpi毁损术,其中1例行同期单侧Gpi及VL毁损术,术前及术后12月应用motorUPDRS量表进行评价。结果2例VL毁损术后12月,肢体静止性震颤完全或基本消除,其中1例下颌静止震颤有明显缓解;26例行Gpi毁损术,术后静止性震颤、僵直、运动迟缓均有较大改善。结论微电极引导立体定向手术是治疗老龄PD的有效手段之一,但是要严格掌握适应证。

Objective To study the treatment methods and outcome of 28 aging patients with PD treated with microelectrode guided stereotactic pallidotomy and thalamotomy.Methods The localization of target was achieved by both MRI and CT scans.Pallidal and thalamal target sites were chosen by supervision of microelectrode recording technique in 28 aging patients above 70 years old with PD 2 type A patients underwent unilateral ventrolateral thalamotomy,and 1 contemporary bilateral ventrolateral thalamotomy and pallidotomy.26 patients underwent unilateral posteroventral pallidotomy,1 contemporary unilateral ventrolateral thalamotomy and posteroventral pallidotomy.Preoperatively,the UPDRS motor score was identified,and followed up 12 months interval.Results After 12 months follow up monitoring,tremor was resolved completely or nearly completely in 2 patients who underwent unilateral and 1 of them bilateral ventrolateral thalamotomy and pallidotomy,and mandible tremor was improved.Dramatic improvement of tremor,rigidity,bradykinesia were observed in 26 patients underwent posteroventral pallidotomy,among them.Conclusion Microelectrode guided stereotactic pallidotomy and thalamotomy are of effective measures for treatment of PD,but the indication should be controlled seriously.