Iacono R P, Lonser R R, Mandybur G, Morenski J D, Yamada S, Shima F
Division of Neurosurgery, Loma Linda University Medical Center, California.
Am Surg. 1994 Oct;60(10):777-82.
Fetal graft research and renewed interest in Leksell's postero-ventral pallidotomy (PVP) stimulated reconsideration of surgical therapy for Parkinson's disease (PD), particularly with regard to improving akinetic symptoms previously thought resistant to surgical lesions. Review of our series and other published results of PVP and fetal graft show that PVP has beneficial effects on both akinetic and hyperkinetic symptoms that better the results reported for fetal graft implantation and other conventional stereotactics. Presented are the results of 60 consecutive patients, 55 of whom underwent PVP, and 5 who underwent fetal graft implantation. Using the Unified Parkinson's Disease Rating Scale (UPDRS), we found that PVP gave significant (P < 0.05) reductions in akinetic symptomatology including freezing, arising from a chair, posture, gait, postural instability, and bradykinesia. Fetal graft patients had significant reductions in two akinetic symptoms: bradykinesia and postural instability. PVP's dramatic therapeutic effects on akinesia may be explained by interruption of amplified collateral inhibitory output from the pallidum to brain stem locomotor centers such as the pedunculopontine nucleus, whereas interruption of collaterals to ventral lateral thalamus by PVP may account for the elimination of hyperkinesia. The excellent results of PVP represent a significant advance in the surgical treatment of PD.
胎儿移植研究以及对莱克塞尔后腹侧苍白球切开术（PVP）重新燃起的兴趣，促使人们重新审视帕金森病（PD）的外科治疗，尤其是在改善先前认为对手术损伤有抵抗性的运动不能症状方面。回顾我们的系列病例以及其他已发表的PVP和胎儿移植的结果表明，PVP对运动不能和运动过多症状均有有益效果，比报道的胎儿移植植入术和其他传统立体定向手术的效果更好。本文展示了连续60例患者的结果，其中55例行PVP，5例行胎儿移植植入术。使用统一帕金森病评定量表（UPDRS），我们发现PVP能显著（P < 0.05）减轻运动不能症状，包括冻结现象、从椅子上起身、姿势、步态、姿势不稳和运动迟缓。胎儿移植患者的两种运动不能症状有显著减轻：运动迟缓和姿势不稳。PVP对运动不能的显著治疗效果可能是由于中断了从苍白球到脑干运动中枢（如下橄榄核）的放大的侧支抑制输出，而PVP对腹外侧丘脑侧支的中断可能解释了运动过多症状的消除。PVP的出色结果代表了PD外科治疗的重大进展。
