Cahan Leslie D, Young Ronald F, Li Francisco
Prog Neurol Surg. 2018;33:149-157. doi: 10.1159/000481083. Epub 2018 Jan 12.
Deep brain stimulation (DBS) has been widely accepted as a tool for treating many symptoms of Parkinson's disease (PD); pallidotomy has been nearly abandoned. Concerns about both the safety and efficacy of pallidotomy are based on small series, isolated case reports, and techniques that would now be considered obsolete. The senior author recently reviewed long-term follow-up of a series of patients who had gamma knife pallidotomy (GKP) for advanced PD. GKP leads to durable, clinically significant benefit. Bilateral GKP adds incremental improvement. The complication rate was 4% when calculated on a per lesion basis. GKP is not quite as effective as DBS for tremor and bradykinesia; the results of GKP and DBS are equivalent for dyskinesia. GKP should be considered in patients who are not candidates for DBS. GKP is not as invasive as radiofrequency pallidotomy and avoids the problems and expenses associated with DBS. Patients on anticoagulants, with cognitive deficits or with other contraindications to DBS can be offered GKP to alleviate many of the motor symptoms of PD.
脑深部电刺激术（DBS）已被广泛认可为治疗帕金森病（PD）多种症状的一种手段；苍白球切开术已几乎被摒弃。对苍白球切开术安全性和有效性的担忧是基于小样本系列研究、个别病例报告以及如今被视为过时的技术。资深作者最近回顾了一系列因晚期帕金森病接受伽玛刀苍白球切开术（GKP）患者的长期随访情况。GKP可带来持久且具有临床意义的益处。双侧GKP可带来额外改善。按每个靶点计算，并发症发生率为4%。对于震颤和运动迟缓，GKP的效果不如DBS；对于异动症，GKP和DBS的效果相当。对于不适合接受DBS的患者，应考虑GKP。GKP不像射频苍白球切开术那样具有侵入性，且避免了与DBS相关的问题和费用。对于正在接受抗凝治疗、存在认知缺陷或有其他DBS禁忌证的患者，可采用GKP来缓解帕金森病的许多运动症状。
