Microelectrode guided stereotactic surgery for Parkinson's disease / 中国微创外科杂志

ABSTRACT

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.