微电极记录在定向苍白球毁损治疗帕金森病手术中的应用

目的:提高苍白球毁损术的定位精度.方法:通过微电极细胞电生理记录技术对70例71次苍白球毁损术进行苍白球内细胞电生理记录,分析电信号,确定手术靶点.结果:经微电极细胞电生理记录及分析.最终手术靶点较CT靶点更换率为82.8%,手术效果显著,并发症少.结论:通过微电极细胞电生理记录技术对苍白球毁损术进行术中定位监测,能够克服个体脑内靶点在解剖上和功能上的变异,提高了定位的精确度和治疗效果.     

微电极导向苍白球腹后部毁损术治疗帕金森病

目的探讨苍白球腹后部毁损术(PVP)治疗帕金森病(PD)的手术方法及疗效。方法采用坐标定位结合MRI图象定位,在微电极导向下,完成对6例病人单侧苍白球腹后部(Gpi)的定位,并实施毁损。结果6例病人的震颤、僵硬及运动迟缓均得到明显改善,UPDRS运动部分积分“开”状态下改善率32．2％,“关”状态下改善率58．6％,无永久并发症。结论坐标结合MRI图象法能准确定位Gpi,微电极记录是其必要的补充。PVP能全面改善PD病人的征象,是一种安全有效的方法。     

苍白球腹后部毁损术中的靶点定位方法探讨

目的：总结苍白球腹后部毁损术中靶点定位方法。方法：进行MRI扫描,前50例采用坐标定位法计算靶点坐标,记录微电极2－4个针道,平均2．6个针道;后191例采用坐标定位和图像定位相结合方法计算靶点坐标,每例记录1－2个针道,平均1．3个针道。结果：MRI图像能清晰显示苍白球各部分、髓板、内囊及视束等结构。微电极记录可确认苍白球内侧部上下界、视束等结构。前50例患靶点X、Y和Z轴坐标调整的百分数均明显高于后191例患,分别为40．0％vs18.8%,38.0%,vs15.2%和82．0%vs62.3%。结论：MRI坐标定位和图像定位相结合,减少了个体差异引起的误差,使MRI定位更加准确。微电极记录技术是MRI定位方法的必要补充。     

苍白球毁损对帕金森病相关疼痛的缓解

0 引言疼痛是帕金森病(Parkinsons disease,PD)较常见症状,发生率15%～46%[1].为探讨苍白球毁损对其疗效,我们随访了患者21例,现报道如下.     

微电极导向苍白球腹后部毁损术治疗帕金森病

目的 探讨苍白球后部毁损术（PVP0治疗帕金森病（PD）的手术方法及疗效。方法 采用坐标定位结合MRI图象定位,在微电极导向下,完成对6例病人单侧苍白球腹后部（Gpi)的定位,并实施毁损。结果 6例病人的震颤、僵硬及运动迟缓均得到明显改善,UPDRS运动部分积分“开”状态下改善率32．2％,“关”状态下改善率58．6％,无永久并发症。结果 坐标结合MRI图像法能确定位Gpi,微电极记录是其必要的补充。PVP能全面改善PD病人的征象,是一种安全有效的方法。     

微电极靶点定位外科治疗帕金森病

目的：探讨微电极记录技术在帕金森病外科治疗中的作用。方法：采用微电极电生理记录技术监测术中靶点,对帕金森病３１例进行手术治疗,其中苍白球毁损术１４例、丘脑毁损术６例、深部脑电刺激术１１例。结果：最终毁损靶点较ＭＲ定位靶点位置更换率为８０．６％,手术效果优良,有效率１００％,原发有太术后改善率达８７．１％,无永久并发症。结论：微电极记录技术的应用能显著提高定位精度,减少并发症和提高手术效果。     

微电极导向苍白球腹后部毁损椁治疗帕金森病

目的 观察微电极导向苍白球部后毁损术治疗帕金木病的临床疗效。方法 应用微电极 导向苍白球腹后部毁损桩治疗２４例帕金森病患者,分析其术后临床症状的改善情况,平均随访时间４．２个月。结果 术中靶点调整率８２．５％,手术有效率１００％,不同症状的改善率（％）分别为,僵直９１．０,运动迟缓８６．７,震颤８３．３,步态７３．４,平均６８．５,“关”状态７６．０。左旋多巴引起的并发症基本消除,无严重及主并发症     

帕金森病苍白球和丘脑毁损术的手术方式选择与疗效关系

目的　总结帕金森病 (PD)苍白球和丘脑毁损术的术式的选择与疗效关系。方法　对 2 13例PD进行了微电极导向立体定向手术治疗 ,其中苍白球腹后部毁损术 (PVP) 171例 ;丘脑腹中间核 (Vim)毁损术 2 1例 ;同期同侧PVP和Vim毁损术 8例 ;同期双侧PVP 5例 ;分期双侧PVP8例。结果　术后UPDRS评分发现上述各种术式在“关”状态下和“开”状态下症状均有明显改善 ,改善率分别为 5 0 .8%～ 6 0 .8%和 2 8.7%～ 36 .6 % ,其中以多靶点毁损术为佳。同期双侧PVP发生明显构音障碍、吞咽困难 1例。结论　根据不同症状选择不同术式 ,同期双侧PVP术后易产生并发症 ,应慎重采用     

微电极靶点定位外科治疗帕金森病

目的探讨微电极记录技术在帕金森病外科治疗中的作用。方法采用微电极电生理记录技术监测术中靶点，对帕金森病31例进行手术治疗，其中苍白球毁损术14例、丘脑毁损术6例、深部脑电刺激术11例。结果最终毁损靶点较MR定位靶点位置更换率为80．6％，手术效果优良，有效率100％，原有症状术后改善率达87．1％，无永久并发症。结论微电极记录技术的应用能显著提高定位精度，减少并发症和提高手术效果。     

立体定向毁损术在脑功能性疾病中的应用

目前对于一些脑功能性疾病，帕金森氏病、书写痉挛、特发性震颤的药物治疗，存在一定局限性，有些药物长期应用导致药效下降，疗效降低，且副作用逐渐增大。立体定向毁损是近年来微创外科开展的治疗脑功能性疾病手术之一，是应用毁损方法通过阻止神经传导束的异常冲动，使失衡的乙酰胆碱、多巴胺等神经递质达到新的平衡，从而改善临床症状。2004年以来，我们采用脑立体定向毁损术治疗脑功能性疾病，取得了较好的疗效，为临床治疗提供了依据，现报告如下。     

立体定向丘脑腹外侧核毁损治疗帕金森病

目的 探讨影响立体定向丘脑腹外侧核毁损术治疗帕金森病疗效的因素。方法 分析１６年来采用立体定向丘脑腹外侧核毁损术治疗帕金森的影像学改变及影响疗效的因素分析，并将１９９０年以前与以后的资料进行比较。结果 本组病便症状完全控制９５０例（７４．２１％），症状控制伴有肢体麻木、情感、智能障碍２７０例（２１．０９％），无效５０例（３．９％），恶化１０例（０．７８％）。结论 ＣＴ定位靶定点与脑室造影定位法对疗     

Subthalamic prelemniscal radiation stimulation for the treatment of Parkinson's disease: electrophysiological characterization of the area

Previous reports have provided evidence of a reticulo-thalamic system, extending from the mesencephalic reticular formation (MRF) to the ventrolateral thalamus (VL), involved in the production of tremor. In humans, a funnel of fibers in the posterior subthalamus named the prelemniscal radiations (Raprl) has been described as an exquisite target to treat tremor in cases of Parkinson's disease.In the present study, a group of 14 patients suffering from Parkinson's disease, with prominent unilateral tremor and rigidity, were implanted with tetrapolar depth brain stimulation (DBS) electrodes in Raprl to perform chronic electrical stimulation (ES) for the treatment of patient symptoms. Electrodes were left externalized to corroborate their placement throughout MRI studies and also to perform the following electrophysiological battery: (a) recording of somatosensory-evoked responses (SEP) through different electrode contacts and scalp by means of a paradigm to study the attention process; (b) evoking scalp EEG responses by stimulation with low (3 cps, 6 cps) and high (60-120 cps) frequencies with stimuli delivered through different electrode contacts, and (c) studying recovery cycle (RC) potentials in the Raprl while the upper MRF was being stimulated and, conversely, the RC in MRF while Raprl was being stimulated, before and after subacute Raprl stimulation. Thereafter, the electrodes were internalized and connected to a pulse generator (IPG) to carry on chronic ES, while the effects of stimulation were determined through a quantitative evaluation that measured phasic and tonic muscular activity with EMG recordings during different motor tasks.Results indicate the following: (a) that late, but not early, SEP components were recorded in Raprl and modulated in different attentive conditions; (b) that bilateral recruiting responses and spike and wave complexes were elicited by Raprl through low-frequency stimulation, while bilateral positive DC shifts induced by high-frequency stimulation were recorded, similar to those obtained in animals from MRF, and (c) that Raprl-ES induced RC inhibition at Raprl, but Raprl ES did not change MRF-RC. Long-term Raprl-ES induced a significant decrease in tremor and rigidity.It was concluded that Raprl represents a subthalamic circuit electrophysiologically related to MRF in the genesis of tremor and rigidity and in the process of selective attention. Raprl-ES induced a significant improvement in tremor and rigidity by causing inhibition of the stimulated area.     

The treatment of Parkinson's disease

In the management of Parkinson's disease physicians now have at their disposal a number of useful therapeutic tools (Figure 3). (Formula: see text) Anticholinergic drugs and amantadine suffice in the early stages of the disease when little disability is present. Levodopa combined with a peripheral decarboxylase inhibitor is the treatment of choice thereafter, and with the appearance of fluctuations it is necessary to increase the frequency of dosage of levodopa and to consider adding bromocriptine. Stereotactic surgery is useful in patients with severe tremor which is unresponsive to drug therapy.