Krauss J K, Jankovic J
Baylor College of Medicine, Houston, Texas, USA.
Am Fam Physician. 1996 Oct;54(5):1621-9.
Improved understanding of the pathophysiologic mechanisms underlying parkinsonian signs and symptoms, as well as refinement of methods and techniques in neurosurgery, neuroradiology and neurophysiology, have stimulated the current interest in and expanded the role of surgical treatment of Parkinson's disease. Pallidotomy and thalamotomy are the stereotactic procedures most commonly performed in patients who fall to obtain satisfactory relief of their symptoms despite optimal medical therapy. Small lesions disrupt the abnormal activity of basal ganglia circuitry. Other options currently being studied include chronic high-frequency stimulation and transplantation of fetal mesencephalic tissue. Chronic thalamic stimulation, involving permanent implantation of a deep brain electrode and a pulse generator, effectively controls contralateral tremor. Fetal nigral transplantation, which is still an experimental procedure, has the potential of restoring lost nigrostriatal pathway. The choice of treatment depends on the severity of the symptoms and their response, or lack of response, to pharmacologic therapy. With appropriate selection criteria, functional and symptomatic improvement can be achieved in most patients with Parkinson's disease who are treated with neurosurgical procedures. The long-term effects of these treatments, however, await the results of longitudinal studies.
对帕金森氏症体征和症状背后病理生理机制的深入理解，以及神经外科、神经放射学和神经生理学方法与技术的改进，激发了当前对帕金森病外科治疗的兴趣，并扩大了其作用。苍白球切开术和丘脑切开术是在那些尽管接受了最佳药物治疗仍无法获得症状满意缓解的患者中最常进行的立体定向手术。小病灶可破坏基底神经节回路的异常活动。目前正在研究的其他选择包括慢性高频刺激和胎儿中脑组织移植。慢性丘脑刺激，包括永久植入深部脑电极和脉冲发生器，可有效控制对侧震颤。胎儿黑质移植仍是一种实验性手术，具有恢复已丧失的黑质纹状体通路的潜力。治疗方法的选择取决于症状的严重程度以及它们对药物治疗的反应或无反应情况。通过适当的选择标准，大多数接受神经外科手术治疗的帕金森病患者可实现功能和症状改善。然而，这些治疗的长期效果有待纵向研究的结果。
