Department of Neurosurgery, Clínica Universidad de Navarra, Navarra University, Pamplona, Spain.
Department of Neurosurgery, Clínica Universidad de Navarra, Navarra University, Pamplona, Spain.
World Neurosurg. 2021 Mar;147:11-22. doi: 10.1016/j.wneu.2020.11.143. Epub 2020 Dec 1.
Lesioning the Forel field or the subthalamic region is considered a possible treatment for tremoric patients with Parkinson disease, essential tremor, and other diseases. This surgical treatment was performed in the 1960s to 1970s and was an alternative to thalamotomy. Recently, there has been increasing interest in the reappraisal of stimulating and/or lesioning these targets, partly as a result of innovations in imaging and noninvasive ablative technologies, such as magnetic resonance-guided focused ultrasonography.
We wanted to perform a thorough review of the subthalamic region, both from an anatomic and a surgical standpoint, to offer a comprehensive and updated analysis of the techniques and results reported for patients with tremor treated with different techniques.
We performed a systematic review of the literature, gathering articles that included patients who underwent ablative or stimulation surgical techniques, targeting the pallidothalamic pathways (pallidothalamic tractotomy), cerebellothalamic pathway (cerebellothalamic tractotomy), or subthalamic area.
Pallidothalamic tractotomy consists of a reduced area that includes pallidofugal pathways. It may be considered an interesting target, given the benefit/risk ratio and the clinical effect, which, compared with pallidotomy, involves a lower risk of injury or involvement of vital structures such as the internal capsule or optic tract. Cerebellothalamic tractotomy and/or posterior subthalamic area are other alternative targets to thalamic stimulation or ablative surgery.
Based on the significant breakthrough that magnetic resonance-guided focused ultrasonography has meant in the neurosurgical world, some classic targets such as the pallidothalamic tract, Forel field, and posterior subthalamic area may be reconsidered as surgical alternatives for patients with movement disorders.
损毁 Forel 区或丘脑下核被认为是治疗帕金森病、特发性震颤和其他疾病震颤患者的一种可能方法。这种手术治疗在 20 世纪 60 年代至 70 年代进行，是丘脑切开术的替代方法。最近，由于成像和非侵入性消融技术（如磁共振引导聚焦超声）的创新，人们对重新评估刺激和/或损毁这些靶点的兴趣日益增加。
我们希望从解剖和手术的角度对丘脑下核进行全面回顾，为不同技术治疗震颤患者的报告技术和结果提供全面、最新的分析。
我们对文献进行了系统回顾，收集了包括接受消融或刺激手术技术的患者的文章，这些技术的靶点是苍白球丘脑束（苍白球丘脑束切开术）、小脑丘脑束（小脑丘脑束切开术）或丘脑下区。
苍白球丘脑束切开术的范围缩小，包括苍白球传出通路。考虑到获益/风险比和临床效果，它可能是一个有趣的靶点，与苍白球切开术相比，它涉及较低的损伤风险或涉及内囊或视束等重要结构的风险。小脑丘脑束切开术和/或丘脑下后区是丘脑刺激或消融手术的其他替代靶点。
基于磁共振引导聚焦超声在神经外科领域的重大突破，一些经典靶点，如苍白球丘脑束、Forel 区和丘脑下后区，可能会被重新考虑作为运动障碍患者的手术选择。
