Iacopino D G, Lucerna S, Giller C A, Salpietro F M, Lo Presti R, Sessa E, Di Bella P, Bramanti P, Tomasello F
Neurosurgical Clinic, University of Messina, Italy.
Funct Neurol. 1998 Apr-Jun;13(2):105-15.
Pallidotomy has recently been reconfirmed as effective for otherwise intractable symptoms of Parkinson's disease. Nonetheless almost every aspect of its performance requires choices which are not fully established and may vary between centers. These include: 1) patient selection; 2) choice of imaging modality, 3) choice of anatomic landmarks for targeting the lesion, 4) choice of method for physiologic confirmation of location, 5) choice of lesion size and shape. We present two cases of pallidotomy procedures in Parkinsonian patients that in our knowledge are the first reported in Italy. Our experience and a careful review of the literature led to the following choices: 1) selection of Parkinsonian patients with dominant L-Dopa induced dyskinesia, akinetic and rigidity symptoms, 2) use of CT due to the distortion effects of MRI, 3) use of standard (Laitinen) coordinates combined with an image fusion method using MRI, 4) use of stimulation to gauge distance to internal capsule and optic tract, 5) production of vertical lesion covering internal segment of pallidum. At a 1-year follow-up the results include a 45% drop in UPDRS (Unified Parkinson's Disease Rating Scale) motor score and almost complete resolution of contralateral dopa induced dyskinesias in both patients.
苍白球切开术最近再次被证实对帕金森病其他难以治疗的症状有效。尽管如此，其操作的几乎每个方面都需要做出尚未完全确定且可能因中心而异的选择。这些选择包括：1）患者选择；2）成像方式的选择；3）靶向病变的解剖标志的选择；4）位置生理确认方法的选择；5）病变大小和形状的选择。我们介绍了两例帕金森病患者的苍白球切开术病例，据我们所知，这是意大利首次报道的此类病例。我们的经验以及对文献的仔细回顾得出了以下选择：1）选择左旋多巴诱发的运动障碍、运动不能和强直症状占主导的帕金森病患者；2）由于磁共振成像（MRI）的畸变效应而使用计算机断层扫描（CT）；3）使用标准（莱蒂宁）坐标并结合使用MRI的图像融合方法；4）使用刺激来测量与内囊和视束的距离；5）制作覆盖苍白球内侧段的垂直病变。在1年的随访中，结果包括统一帕金森病评定量表（UPDRS）运动评分下降45%，且两名患者对侧多巴诱发的运动障碍几乎完全消失。
