丘脑底核电刺激治疗苍白球毁损术后的帕金森病(12例报告)

目的探讨帕金森病(Parkinson's disease,PD)苍白球腹后部毁损术(posteroventral pallidotomy,PVP)后再行丘脑底核(subthalamic nucleus,STN)脑深部电刺激术(deep brain stimulation,DBS)的可行性、术中电生理学特点和治疗结果。方法应用MR和微电极记录技术进行靶点定位,对12例单侧PVP术后症状再次加重的PD患者实施STN-DBS手术,其中4例行毁损灶对侧的STN-DBS,8例行双侧STN-DBS。结果STN-DBS对本组12例PD患者症状有不同程度的改善,双侧STN-DBS的效果尤为明显,术后3个月的UPDRS运动及ADL评分较术前明显减少(P<0．05或0．01),美多巴的用量明显减少(P<0．01),无明显术后并发症。术中电生理记录显示毁损灶同侧的细胞放电明显低于正常情况。结论曾行单侧PVP的PD患者如面临二次手术,可以选择DBS手术,以双侧STN的DBS效果最好,可减少药物用量。

Subthalamic stimulation in the treatment of Parkinson''''s disease with a prior unilateral posteroventral pallidotomy——Report of 12 cases

Objective Practicability, intraoperative electro-physiological characteristics and surgical outcome were explored among Parkinson's disease (PD) patients who underwent subthalamic nucleus-deep brain stimulation (STN-DBS) with a previous unilateral posteroventral pallidotomy (PVP). Methods With the help of MR and microelectrode recording technique in target localization, 12 PD patients with previous unilateral PVP whose symptoms deteriorated underwent STN-DBS surgery. Among them, eight underwent bilateral STN-DBS, while the others underwent unilateral STN-DBS. Results STN-DBS could improve symptoms of PD patients with a previous posteroventral pallidotomy ( PVP) , especially those who underwent bilateral STN-DBS. UPDRS motor and ADL scores decreased prominently and dosage of L-Dopa intake decreased significantly three months after operation. No surgical complication occurred. Conclusions If patients with a prior unilateral PVP need a second operation, STN-DBS could be an effective method. Bilateral STN-DBS not only led to the best symptomatic improvement and reduction in L-Dopa intake in patients, but also avoided new surgical complications.