Merello M, Cammarota A, Cerquetti D, Leiguarda R C
Movement Disorders Section, Raul Carrea Institute for Neurological Research (FLENI), Montañeses 2325, (1428) Buenos Aires, Argentina.
J Neurol Neurosurg Psychiatry. 2000 Dec;69(6):787-91. doi: 10.1136/jnnp.69.6.787.
Over the past few years many reports have shown that posteroventral pallidotomy is an effective method for treating advanced cases of Parkinson's disease. The main differences with earlier descriptions were the use of standardised evaluation with new high resolution MRI studies and of single cell microrecording which can electrophysiologically define the sensorimotor portion of the internal globus pallidus (GPi). The present study was performed on a consecutive series of 40 patients with Parkinson's disease who underwent posteroventral pallidotomy to determine localisation discrepancies between the ventriculography based theoretical and the electrophysiologically defined target for posteroventral pallidotomy.
The tentative location of the posteroventral GPi portion was defined according to the proportional Talairach system. Single cell recording was performed in all patients. The definitive target was chosen according to the feasibility of recording single cells with GPi cell features, including the presence of motor drive and correct identification of the internal capsule and of the optic tract by activity recording and microstimulation.
In all 40 patients the electrophysiologically defined sensorimotor portion of the GPi was lesioned, with significantly improved cardinal Parkinson's disease symptoms as well as levodopa induced dyskinesias, without damage to the internal capsule or optic tract. Significant differences between the localisation of the ventriculography based theoretical versus electrophysiological target were found in depth (p<0.0008) and posteriority (p<0.04). No significant differences were found in laterality between both approaches. Difference ranges were 8 mm for laterality, 6.5 mm for depth, and 10 mm for posteriority.
Electrophysiologically defined lesion of GPi for posteroventral pallidotomy, shown to be effective for treating Parkinson's disease, is located at a significantly different site from the ventriculography based theoretical target.
在过去几年中，许多报告表明，后腹侧苍白球切开术是治疗帕金森病晚期病例的有效方法。与早期描述的主要差异在于使用标准化评估以及新的高分辨率MRI研究和单细胞微记录，后者可从电生理角度界定内侧苍白球（GPi）的感觉运动部分。本研究对连续40例接受后腹侧苍白球切开术的帕金森病患者进行，以确定基于脑室造影的理论靶点与后腹侧苍白球切开术电生理界定靶点之间的定位差异。
根据比例Talairach系统确定后腹侧GPi部分的暂定位置。对所有患者进行单细胞记录。根据记录具有GPi细胞特征的单细胞的可行性选择最终靶点，这些特征包括运动驱动的存在以及通过活动记录和微刺激正确识别内囊和视束。
在所有40例患者中，GPi的电生理界定感觉运动部分均受到损伤，帕金森病主要症状以及左旋多巴诱发的异动症均有显著改善，且未损伤内囊或视束。基于脑室造影的理论靶点与电生理靶点的定位在深度（p<0.0008）和后位（p<0.04）方面存在显著差异。两种方法在侧位方面未发现显著差异。侧位差异范围为8mm，深度差异范围为6.5mm，后位差异范围为10mm。
后腹侧苍白球切开术对GPi进行电生理界定的损伤被证明对治疗帕金森病有效，其位置与基于脑室造影的理论靶点有显著差异。
