Institute of Neurobiology, Universidad Nacional Autónoma de México, Campus Juriquilla, Juriquilla, Mexico.
Unit for Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Ciudad de México, Mexico.
Oper Neurosurg (Hagerstown). 2020 Oct 15;19(5):539-550. doi: 10.1093/ons/opaa186.
Prelemniscal radiations (Raprl) are composed of different fiber tracts, connecting the brain stem and cerebellum with basal ganglia and cerebral cortex. In Parkinson disease (PD), lesions in Raprl induce improvement of tremor, rigidity, and bradykinesia in some patients, while others show improvement of only 1 or 2 symptoms, suggesting different fiber tracts mediate different symptoms.
To search for correlations between improvements of specific symptoms with surgical lesions of specific fiber tract components of Raprl in patients with PD.
A total of 10 patients were treated with unilateral radiofrequency lesions directed to Raprl. The improvement for tremor, rigidity, bradykinesia, posture, and gait was evaluated at 24 to 33 mo after operation through the Unified Parkinson's Disease Rating Scale (UPDRS) score, and the precise location and extension of lesions through structural magnetic resonance imaging and probabilistic tractography at 6 to 8 mo postsurgery. Correlation between percentage of fiber tract involvement and percentage of UPDRS-III score improvement was evaluated through Spearman's correlation coefficient.
Group average improvement was 86% for tremor, 62% for rigidity, 56% for bradykinesia, and 45% for gait and posture. Improvement in global UPDRS score correlated with extent of lesions in fibers connecting with contralateral cerebellar cortex and improvement of posture and gait with fibers connecting with contralateral deep cerebellar nuclei. Lesion of fibers connecting the globus pallidum with pedunculopontine nucleus induced improvement of gait and posture over other symptoms.
Partial lesion of Raprl fibers resulted in symptom improvement at 2-yr follow-up. Lesions of selective fiber components may result in selective improvement of specific symptoms.
前连合辐射（Raprl）由不同的纤维束组成，连接脑干和小脑与基底节和大脑皮层。在帕金森病（PD）中，Raprl 中的病变导致一些患者震颤、僵硬和运动迟缓改善，而其他患者仅改善 1 或 2 种症状，这表明不同的纤维束介导不同的症状。
寻找帕金森病患者 Raprl 中特定纤维束成分的手术病变与特定症状改善之间的相关性。
对 10 例患者行单侧 Raprl 射频消融术。术后 24 至 33 个月通过统一帕金森病评定量表（UPDRS）评分评估震颤、僵硬、运动迟缓、姿势和步态的改善情况，术后 6 至 8 个月通过结构磁共振成像和概率追踪术评估病变的确切位置和范围。通过 Spearman 相关系数评估纤维束受累百分比与 UPDRS-III 评分改善百分比之间的相关性。
组平均改善率为震颤 86%，僵硬 62%，运动迟缓 56%，姿势和步态 45%。整体 UPDRS 评分的改善与与对侧小脑皮质相连纤维的病变范围相关，姿势和步态的改善与与对侧深部小脑核相连的纤维相关。苍白球与脑桥被盖核相连的纤维病变导致步态和姿势改善优于其他症状。
Raprl 纤维的部分病变导致 2 年随访时症状改善。选择性纤维成分的病变可能导致特定症状的选择性改善。
