Espay Alberto J, Mandybur George T, Revilla Fredy J
Department of Neurology, Movement Disorders Center, The Neuroscience Institute, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0525, Cincinnati, OH 45267-0525, USA.
Clin Geriatr Med. 2006 Nov;22(4):813-25, vi. doi: 10.1016/j.cger.2006.06.002.
A substantial body of evidence has accumulated regarding the efficacy and safety of neurosurgery for Parkinson's disease, essential tremor, and dystonia. Surgery for movement disorders (thalamotomy, pallidotomy, and subthalamic nucleotomy or subthalamotomy) was largely ablative (lesion-based). Given the safety and anatomy-preservation advantage, long-term electrical stimulation of these same targets (thalamus, globus pallidus, and subthalamic nucleus) is discussed as the treatment of choice. High-frequency deep brain stimulation procedures replicate the effects of ablative interventions, but do not require making a destructive brain lesion. This article outlines patient eligibility for surgery, targeting techniques, intraoperative findings, and potential complications and discusses the outcomes expected for each of the major interventions for which clinical trial data are available.
关于神经外科手术治疗帕金森病、特发性震颤和肌张力障碍的疗效及安全性，已有大量证据积累。运动障碍手术（丘脑切开术、苍白球切开术以及丘脑底核切开术或丘脑底核损毁术）在很大程度上是毁损性的（基于病灶的）。鉴于安全性和保留解剖结构的优势，对这些相同靶点（丘脑、苍白球和丘脑底核）进行长期电刺激被视为首选治疗方法。高频深部脑刺激手术可复制毁损性干预的效果，但无需造成脑损伤。本文概述了手术的患者入选标准、靶点定位技术、术中发现及潜在并发症，并讨论了每种有临床试验数据的主要干预措施预期的治疗效果。
