微电极导向立体定向手术治疗帕金森病应用

Microelectrode guided stereotactic surgery for Parkinson's disease

目的 评价微电极导向立体定向脑内核团毁损术和脑深部电刺激 (Deepbrainstimulation ,DBS)治疗帕金森病的临床疗效。 方法 1999年 4月～ 2 0 0 3年 3月采用微电极导向立体定向毁损手术治疗帕金森病 5 10例 (毁损手术组 )和DBS治疗帕金森病 30例 (电刺激组 )。毁损手术组中行单侧苍白球腹后部毁损术 (Posteroventralpallidotomy ,PVP) 385例 ,丘脑腹中间核(Ventralintermedius,Vim)毁损术 91例 ,行同期同侧PVP和Vim毁损术 12例 ,同期双侧PVP 8例 ,分期双侧PVP 10例 ,分期一侧PVP、另一侧Vim毁损术 4例。电刺激组中 ,刺激靶点为丘脑底核 (Subthalamicnucleus,STN) 2 9例和Vim 1例 ,其中单侧 18例 ,双侧 12例。 结果 毁损手术组术后UPDRS运动评分 ,在“关”状态下 ,症状改善率为 4 7 3% ,在“开”状态下症状改善率38 7%。开 -关症状和异动症均消失。 2 2 0例随访平均 11 6月 ,其中显效 130例 (5 9 1% ) ,改善 75例 (34 1% ) ,无效 15例(6 8% )。电刺激组术后在“关”状态下UPDRS运动评分改善率 4 5 2 % ,在“开”状态下改善率 2 5 7% ,30例随访平均 10 3月 ,其中 18例于 1月内调整参数后再无调整参数 ,12例术后需再次调整参数。 结论 对伴震颤的帕金森病苍白球损毁术较丘脑损毁术更有效。脑深?

ObjectiveTo evaluate the clinical effects of microelectrode guided stereotactic pallidotomy and/or thalamotomy and deep brain stimulation (DBS) in the management of Parkinson's disease.MethodsA total of 510 patients with P arkinson's disease underwent stereotactic operations and 30 patients underwent D BS from April 1999 to March 2003. The 510 cases consisted of 385 cases of poster oventral pallidotomy (PVP), 91 cases of ventral intermedius (Vim) thalamotomy, 1 2 cases of PVP together with Vim thalamotomy on the same side, 8 cases of PVP on both sides at the same time, 10 cases of PVP on both sides at different times, and 4 cases of PVP on one side while Vim thalamotomy on the other at different t imes. Of the 30 cases of DBS (unilateral, 18 cases; bilateral, 12 cases), target s were located in subthalamic nucleus(STN) in 29 cases and ventralis intermedius nucl eus in 1 case.ResultsUnified Parkinson's disease rating scal e (UPDRS) scores were recorded postoperatively. Of the 510 cases, during the “off” and “on” stat es, symptoms improved by 47 3% and 38 7%, respectively. “On-off” phenomena a nd m otor symptoms disappeared. Follow-up information with a mean of 11 6 months in 2 20 cases revealed excellent outcomes in 130 cases (59 1%), improved in 75 (34 1%), a nd no change in 15 (6 8%). Of the 30 cases of DBS, during the “off” and “on ” state s, symptoms improved by 45 2% and 25 7%, respectively. All the 30 patients wer e followed for a mean of 10.3 months. No parameter adjustment was needed after 1 p ostoperative month in 18 cases, while the adjustment after operation was require d in the remaining 12 cases.ConclusionsPallidotomy is much m ore effective th an thalamotoy in Parkinson's patients with tremor. DBS can effectively control t he patient's motor symptoms.