Trépanier L L, Kumar R, Lozano A M, Lang A E, Saint-Cyr J A
Toronto Western Hospital--Research Institute, University of Toronto and The Toronto Hospital, Ontario, Canada.
Brain Cogn. 2000 Apr;42(3):324-47. doi: 10.1006/brcg.1999.1108.
This paper highlights the neuropsychological sequelae of posteroventral pallidotomy (PVP) and deep brain stimulation (DBS) of the subthalamic nucleus (STN) and the internal segment of the globus pallidus (GPi) at 3/6 months postoperatively. Results are based on our extensive experience with PVP and our preliminary observations with DBS. Patients with borderline cognitive or psychiatric functioning risk postoperative decompensation. Nonlateralizing attentional and hemisphere-specific impairments of frontostriatal cognitive functions followed unilateral PVP. "Frontal" behavioral dyscontrol was observed in approximately 25% of patients. Three cases of staged bilateral PVP suggest that premorbid factors may predict outcome, although lesion size and location are also critical. Older patients are at risk for significant cognitive and behavioral decline after bilateral STN DBS, while GPi DBS may be safer.
本文着重介绍了术后3/6个月时，后腹侧苍白球切开术（PVP）以及丘脑底核（STN）和苍白球内侧部（GPi）的脑深部电刺激（DBS）所导致的神经心理学后遗症。研究结果基于我们在PVP方面的丰富经验以及对DBS的初步观察。认知功能或精神功能处于临界状态的患者术后有失代偿风险。单侧PVP后会出现非偏侧性注意力和额叶纹状体认知功能的半球特异性损害。约25%的患者出现了“额叶”行为失控。3例分期双侧PVP病例表明，尽管病变大小和位置也很关键，但病前因素可能预测结果。老年患者在双侧STN-DBS后有显著认知和行为衰退的风险，而GPi-DBS可能更安全。
