Blond S, Musolino A, Munari C, Gasnault J, Chauvel P, Chodkiewicz J P, Talairach J
Service de Neurochirurgie, Centre Hospitalier Ste Anne, Paris.
Neurochirurgie. 1987;33(6):455-61.
Authors report a study concerning 12 dyskinetic patients with cerebral palsy. The clinical pre-operative examination shows that many signs and symptoms are associated: volitional and postural dyskinesia, athetosis and dystonia, pyramidal deficit and spasticity. Talairach's stereotactic methodology has been used for bifocal (VPL thalamic nucleus and internal pallidum) Yttrium 90 implantation. After stereotactic bifocal lesions, involuntary movements have been reduced in 45.5% of cases and have disappeared in 27% of cases. Impairment of previous motor deficit has been observed in 3% of cases; volitional and postural dyskinesia seems to be the most curable symptomatology. Clinical results in athetoid involuntary movements and dystonia are less rewarding. Because of important anatomical modifications often observed cerebral palsy patients, the authors stress the interest of individual acute neurophysiological study and discuss about the stereotactic targets and the modalities of destruction. They insist upon the necessity of rigorous selection of indications based on acute clinical examination in the perspective of improvement of global functional capacities.
作者报告了一项针对12例患有脑瘫的运动障碍患者的研究。术前临床检查显示，许多体征和症状相互关联：随意运动和姿势性运动障碍、手足徐动症和肌张力障碍、锥体束征和痉挛。采用了Talairach立体定向方法进行双靶点（丘脑腹外侧核和苍白球内侧部）钇90植入。立体定向双靶点毁损术后，45.5%的病例不自主运动减少，27%的病例不自主运动消失。3%的病例出现了先前运动功能缺损的加重；随意运动和姿势性运动障碍似乎是最可治愈的症状。在手足徐动型不自主运动和肌张力障碍方面的临床效果不太理想。由于经常观察到脑瘫患者存在重要的解剖结构改变，作者强调了个体急性神经生理学研究的重要性，并讨论了立体定向靶点和毁损方式。他们坚持认为，从改善整体功能能力的角度出发，必须基于急性临床检查严格选择适应症。
