Bakay R A, Watts R L, Freeman A, Iuvone P M, Watts N, Graham S D
Department of Neurology, Veterans Administration Medical Center, Atlanta, Ga.
Stereotact Funct Neurosurg. 1990;54-55:312-23. doi: 10.1159/000100228.
The attempt to restore lost neurological function through grafting of catecholaminergic tissue into the striatum is a dramatic new experimental treatment approach for parkinsonism. We have grafted autologous adrenal medullary tissue into the right caudate nucleus in 12 patients with advanced Parkinson's disease (10 males, 2 females, mean age 53 years, mean Hoehn and Yahr stage 'off' medications 4.2) applying a transcortical technique similar to that of Madrazo as modified by Allen using right adrenalectomy performed via a flank approach. There have been no deaths, surgical complications, or serious postoperative morbidity. Modified Columbia Parkinson's disease ratings of patients off all dopaminergic agents for 72 h revealed 22% improvement (p less than 0.01) 3-6 months postoperatively (n = 10) and 22% improvement (p less than 0.01) 7-12 months later (n = 9). Postoperative dyskinesias necessitated reduction of L-dopa by 11% and of carbidopa by 29%. Analysis of lumbar cerebrospinal fluid biogenic amine metabolites following a 4-day 'drug holiday' revealed that homovanillic acid increased to 159% of preoperative levels (p less than 0.01) 3-6 months (n = 9) and to 197% of preoperative levels (p less than 0.02) 7-12 months postoperatively (n = 5). We have observed a mild to moderate improvement persisting up to 1 year with this therapeutic approach, but further study is needed.
通过将儿茶酚胺能组织移植到纹状体来恢复丧失的神经功能，是一种针对帕金森病的全新且引人注目的实验性治疗方法。我们采用了一种经皮质技术，类似于Madrazo的方法并经Allen改良，通过侧腹入路进行右侧肾上腺切除术，将自体肾上腺髓质组织移植到12例晚期帕金森病患者（10例男性，2例女性，平均年龄53岁，“未服药”状态下平均Hoehn和Yahr分期为4.2）的右侧尾状核中。术后无死亡、手术并发症或严重的术后发病率。对停用所有多巴胺能药物72小时的患者进行改良的哥伦比亚帕金森病评分，结果显示术后3 - 6个月（n = 10）改善了22%（p < 0.01），7 - 12个月后（n = 9）改善了22%（p < 0.01）。术后出现的运动障碍使得左旋多巴的用量减少了11%，卡比多巴的用量减少了29%。在4天“药物假期”后对腰椎脑脊液生物胺代谢产物进行分析，结果显示高香草酸在术后3 - 6个月（n = 9）增加到术前水平的159%（p < 0.01），在术后7 - 12个月（n = 5）增加到术前水平的197%（p < 0.02）。我们观察到这种治疗方法带来的轻度至中度改善可持续长达1年，但仍需要进一步研究。
