脑深部电刺激对帕金森病二次手术的临床应用价值.docVIP

脑深部电刺激对帕金森病二次手术的临床应用价值 2004年7月第2O卷第4期ChinJNeurosurg,July20o4,0l,.!?271? ? 立体定向和功能性神经外科研究? 脑深部电刺激对帕金森病二次 手术的临床应用价值 张凯张建国吴胜田王忠诚 【摘要】目的探讨帕金森病(Parkinsonsdisease,PD)毁损术后再行脑深部电刺激术(deepbrain stimulation,DBS)的可行性,靶点选择,术中电生理学特点和治疗结果.方法应用MRI和微电极记录 技术进行靶点定位,对13例毁损术后的PD患者行DBS手术,其中7例曾行单侧苍白球毁损术 (posteroventralpallidotomy,PVP),5例曾行单侧丘脑毁损术,1例曾行双侧丘脑及左侧苍白球毁损术.DBS 的靶点包括单侧丘脑底核(subthalamicnucleus,STN)6例,单侧丘脑腹中间核(ventralintermediate nucleus,Vim)1例,双侧STN4例,一侧STN及对侧苍白球(globuspallidusinternus,Gpi)2例.结果 DBS对毁损术后的PD患者症状有不同程度的改善,其中单侧毁损术后行双侧DBS效果最明显.术后3 个月的UPDRS运动及ADL评分较术前明显减少(Plt;O.05或0.O1),美多巴的用量明显减少(Plt;O.05), 无新的手术合并症.结论曾行毁损术的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,并可减少药物用量,不加重原有的术后并发症. 【关键词】帕金森病;毁损;脑深部电刺激术 ClinicalsignificanceofdeepbrainstimniationinthetreatmentofParkinsonsdiseaseonits secondsurgeryZHANGKai,ZHANGJian-gtto,WUSheng-tian,eta1.Dept.ofNeurosurgery,BeOing TiantanHospital,Beijing100050,China 【Abstract】objectivesPracticability,targetselection,intraoperativeelectrophysiologicalcharacteristics andsurgicaloutcomewereexploredamongPDpatientswhounderwentDBSoperationwithapreviousablation operation.MethodsWiththehelpofMRIandmicroelectroderecordingtechniqueintargetlocalization,13PD patientswithpreviousablationoperationsunderwentDBSsurgery.Amongthesepatients,7hadpreviousunilateral pallidotomy,5hadpreviousunilateralthalamotomy,1hadpreviousbilateralthalamotomyandleftsidepallidotomy. TargetsofDBSincludedunilateralSTNin6cases,unilateralVimin1case,bilateralSTNin4oases,unilateralSTN andcontralateralGpiin2causes.ResultsDBScouldimprovesymptomsofPDpatientswithapreviousablation operationtodifferentextent,especiallythosewithunilateralablationandunderwentbilateralDBS.UPDRSmotorand ADLscoresdecreasedprominentlyanddosageofL—Dopaintakedecreasedsignificantlythreemonthsafteroperation. Nosurgicalcomplicationocculted.ConclusionsIfsymptomsrecurredinpatientswithapriorablationsurgery, DBScouldstillbeaneffectivemethod.BilateralSTN-DBSnotonlyledtothebestsymptomaticimprovementand reductioninL—Dopaintakeinpatients,bu