Starr P A, Vitek J L, Bakay R A
Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.
Neurosurgery. 1998 Nov;43(5):989-1013; discussion 1013-5. doi: 10.1097/00006123-199811000-00001.
Surgical options for Parkinson's disease (PD) are rapidly expanding and include ablative procedures, deep brain stimulation, and cell transplantation. The target nuclei for ablative surgery and deep brain stimulation are the motor thalamus, the globus pallidus, and the subthalamic nucleus. Multiple factors have led to the resurgence of interest in the surgical treatment of PD: 1) recognition that long-term medical therapy for PD is often unsatisfactory, with patients eventually suffering from drug-induced dyskinesias, motor fluctuations, and variable responses to medication; 2) greater understanding of the pathophysiology of PD, providing a better scientific rationale for some previously developed procedures and suggesting new targets; and 3) use of improved techniques, such as computed tomography- and magnetic resonance imaging-guided stereotaxy and single-unit microelectrode recording, making surgical intervention in the basal ganglia more precise. We review the present status of ablative surgery and deep brain stimulation for PD, including theoretical aspects, surgical techniques, and clinical results.
帕金森病（PD）的手术治疗选择正在迅速扩展，包括毁损手术、深部脑刺激和细胞移植。毁损手术和深部脑刺激的目标核团是运动丘脑、苍白球和丘脑底核。多种因素导致了人们对PD手术治疗兴趣的复苏：1）认识到PD的长期药物治疗往往不尽人意，患者最终会出现药物性运动障碍、运动波动以及对药物的反应不一；2）对PD病理生理学有了更深入的了解，为一些先前开发的手术提供了更好的科学依据，并提示了新的靶点；3）使用了改进的技术，如计算机断层扫描和磁共振成像引导的立体定向技术以及单单位微电极记录，使基底神经节的手术干预更加精确。我们回顾了PD毁损手术和深部脑刺激的现状，包括理论方面、手术技术和临床结果。
