Baumgartner Alexander J, Thompson John A, Kern Drew S, Ojemann Steven G
Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
University of Colorado Hospital, 12631 East 17th Avenue, PO Box 6511, Aurora, CO, 80045, USA.
Neurosurg Rev. 2022 Aug;45(4):2593-2613. doi: 10.1007/s10143-022-01770-y. Epub 2022 May 5.
The neurosurgical treatment of movement disorders, primarily via deep brain stimulation (DBS), is a rapidly expanding and evolving field. Although conventional targets including the subthalamic nucleus (STN) and internal segment of the globus pallidus (GPi) for Parkinson's disease and ventral intermediate nucleus of the thalams (VIM) for tremor provide substantial benefit in terms of both motor symptoms and quality of life, other targets for DBS have been explored in an effort to maximize clinical benefit and also avoid undesired adverse effects associated with stimulation. These novel targets primarily include the rostral zona incerta (rZI), caudal zona incerta (cZI)/posterior subthalamic area (PSA), prelemniscal radiation (Raprl), pedunculopontine nucleus (PPN), substantia nigra pars reticulata (SNr), centromedian/parafascicular (CM/PF) nucleus of the thalamus, nucleus basalis of Meynert (NBM), dentato-rubro-thalamic tract (DRTT), dentate nucleus of the cerebellum, external segment of the globus pallidus (GPe), and ventral oralis (VO) complex of the thalamus. However, reports of outcomes utilizing these targets are scattered and disparate. In order to provide a comprehensive resource for researchers and clinicians alike, we have summarized the existing literature surrounding these novel targets, including rationale for their use, neurosurgical techniques where relevant, outcomes and adverse effects of stimulation, and future directions for research.
运动障碍的神经外科治疗主要通过深部脑刺激（DBS）进行，这是一个迅速发展的领域。尽管传统靶点，包括用于帕金森病的丘脑底核（STN）和苍白球内侧部（GPi）以及用于震颤的丘脑腹中间核（VIM），在运动症状和生活质量方面都带来了显著益处，但人们也在探索其他DBS靶点，以最大程度地提高临床效益，并避免与刺激相关的不良副作用。这些新靶点主要包括嘴侧未定带（rZI）、尾侧未定带（cZI）/丘脑后下区（PSA）、丘脑前辐射（Raprl）、脚桥核（PPN）、黑质网状部（SNr）、丘脑中央中核/束旁核（CM/PF）、Meynert基底核（NBM）、齿状红核丘脑束（DRTT）、小脑齿状核、苍白球外侧部（GPe）以及丘脑腹口复合体（VO）。然而，关于使用这些靶点的结果报告分散且各不相同。为了为研究人员和临床医生提供全面的参考资料，我们总结了围绕这些新靶点的现有文献，包括使用它们的理论依据、相关的神经外科技术、刺激的结果和副作用，以及未来的研究方向。
