Linhares M N, Tasker R R
Department of Surgery, Toronto Western Hospital, University of Toronto, Ontario, Canada.
Neurosurgery. 2000 Feb;46(2):390-5; discussion 395-8. doi: 10.1097/00006123-200002000-00024.
To describe the outcomes in our first 40 microelectrode-guided thalamotomies for parkinsonian tremor.
Twenty-four left-sided and 16 right-sided thalamotomies were performed between October 1984 and January 1996; the mean follow-up period was 35.8 months (range, 1-152 mo). The results were evaluated retrospectively and semiquantitatively by a disinterested observer (MNL) and correlated with the quality of the microelectrode recording and the number and size of radiofrequency lesions made. The first 20 and second 20 procedures were evaluated separately.
At the last follow-up, the Unified Parkinson's Disease Rating Scale showed no or virtually no tremor in the upper limb in 75% of patients or in the lower limb in 73% of patients. No significant persistent complications were found. These results were achieved at the expense of having to repeat the procedure on 11 sides (in 5 because of technical problems and in 6 for no obvious reason). Total or nearly total abolition of tremor occurred after the first procedure in 40% of the first 20 operations and in 65% of the second 20. Eight of the first 20 procedures and 2 of the second 20 failed for technical reasons. Lesions were made larger in the second 20 procedures than in the first 20. With the use of an electrode with a 1.1 x 3-mm bare tip for 60 seconds, it seems that lesions had to be created at 60 degrees C or more to produce a successful result.
Thalamotomy with microelectrode recording is an effective procedure with which to treat tremor in patients with Parkinson's disease and may involve fewer complications than conventional techniques. The procedure appears to involve a learning curve.
描述我们最初40例微电极引导丘脑切开术治疗帕金森震颤的结果。
1984年10月至1996年1月期间进行了24例左侧和16例右侧丘脑切开术；平均随访期为35.8个月（范围1 - 152个月）。由一名公正的观察者（MNL）进行回顾性和半定量评估结果，并与微电极记录的质量以及射频损伤的数量和大小相关联。前20例和后20例手术分别进行评估。
在最后一次随访时，统一帕金森病评定量表显示，75%的患者上肢无震颤或几乎无震颤，73%的患者下肢无震颤或几乎无震颤。未发现明显的持续性并发症。这些结果的取得是以11侧需要重复手术为代价的（5侧是由于技术问题，6侧原因不明）。在前20例手术的40%中以及后20例手术的65%中，首次手术后震颤完全或几乎完全消失。前20例手术中有8例、后20例手术中有2例因技术原因失败。后20例手术中的损伤比前20例手术中的损伤更大。使用裸尖为1.1×3毫米的电极60秒，似乎损伤必须在60摄氏度或更高温度下形成才能产生成功的结果。
微电极记录丘脑切开术是治疗帕金森病患者震颤的有效方法，可能比传统技术并发症更少。该手术似乎存在学习曲线。
