Subthalamotomy for Parkinson’s disease: clinical outcome and topography of lesions
Subthalamotomy for Parkinson’s disease: clinical outcome and topography of lesions
复制标题
丘脑下切除术治疗帕金森病：临床结果和病变形态
DOI：
10.1136/jnnp-2017-316241
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发表时间：
2017
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影响因子：
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通讯作者：
J. Obeso
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作者：
R. Rodríguez;M. Carballo;L. Alvarez;J. Guridi;N. Pavón;I. García;R. Macias;M. Rodriguez;J. Obeso
目的丘脑底核毁损术是治疗帕金森病（PD）的有效方法。然而，最佳目标位置的不确定性和诱导hemichorea-ballism的可能性限制了其应用。我们评估了丘脑底核射频损伤的地形图与运动改善和舞蹈症-冲击症出现之间的相关性。方法对64例接受丘脑底核毁损术的帕金森病患者进行术前、术后帕金森病运动功能评分、MRI和纤维束成像检查。根据临床运动改善程度和运动障碍量表对患者进行分类。在MRI上分割病变，并在标准空间中取平均值。我们研究了病变引起的周围纤维破坏的程度和血色素沉着症的发展之间的关系。结果位于小脑背外侧运动区的病灶较位于小脑背侧缘和齿状回的病灶具有最大的抗帕金森效应（分别减少71.3%、53.5%和20.8%）。然而，与完全位于细胞核内的病变相比，向背侧延伸超过小脑延髓的病变导致舞蹈症的可能性较低。纤维束造影结果表明，苍白球丘脑纤维的中断可能决定了一个低概率的出血症，Ballism术后。结论丘脑底核毁损术治疗帕金森病的疗效主要取决于毁损灶的形态。病变涉及运动神经和苍白球丘脑纤维引起显着的运动改善，并与低发病率的舞蹈症，冲击。
Objective Subthalamotomy is an effective alternative for the treatment of Parkinson’s disease (PD). However, uncertainty about the optimal target location and the possibility of inducing haemichorea-ballism have limited its application. We assessed the correlation between the topography of radiofrequency-based lesions of the subthalamic nucleus (STN) with motor improvement and the emergence of haemichorea-ballism. Methods Sixty-four patients with PD treated with subthalamotomy were evaluated preoperatively and postoperatively using the Unified Parkinson’s Disease Rating Scale motor score (UPDRSm), MRI and tractography. Patients were classified according to the degree of clinical motor improvement and dyskinesia scale. Lesions were segmented on MRI and averaged in a standard space. We examined the relationship between the extent of lesion-induced disruption of fibres surrounding the STN and the development of haemichorea-ballism. Results Maximum antiparkinsonian effect was obtained with lesions located within the dorsolateral motor region of the STN as compared with those centre-placed in the dorsal border of the STN and the zona incerta (71.3%, 53.5% and 20.8% UPDRSm reduction, respectively). However, lesions that extended dorsally beyond the STN showed lower probability of causing haemichorea-ballism than those placed entirely within the nucleus. Tractography findings indicate that interruption of pallidothalamic fibres probably determines a low probability of haemichorea-ballism postoperatively. Conclusions The topography of the lesion is a major factor in the antiparkinsonian effect of subthalamotomy in patients with PD. Lesions involving the motor STN and pallidothalamic fibres induced significant motor improvement and were associated with a low incidence of haemichorea-ballism.
Nambu A、Takada M、Tokuno H、Inase M：“灵长类动物底丘脑核中的双重体位表征：初级运动皮层和辅助运动区有序但反向的身体图转换的证据”神经科学杂志。
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