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[Microelectrode-guided posteroventral medial pallidotomy for Parkinson's disease]
1Department of Neurosurgery, Zhujiang Hospital, First Military Medical University, Guangzhou 510282.
Objective:
To introduce the methods and effects of microelectrode-guided posteroventral pallidotomy (PVP) for Parkinson's disease.
Methods:
109 patients underwent PVP by microelectrode electrophysiological recording for intraoperative target localization. 45 patients underwent unilateral PVP, 21 patients simultaneous bilateral PVP, 43 patients combined thalamotomy and PVP. Modified Webster Scale was used for objective assessments before and after operation. Postoperative CT scan or MRI was performed to localise lesions.
Results:
Microelectrode recording usually led to a final pallidotomy lesion position that deviated from the CT stereotactically defined target point. The change rate of targets was 84.7%. PVP significantly and immediately improved all Parkinsonian motor signs and reduced drug-induced motor fluctuations and dyskinesia. The mean Webster Scale was improved by (72.7 +/- 11.3)% in the "on"" state, and (89.3 +/- 8.1)% in the "off" state. No patient showed permanent complications.
Conclusions:
Microelectrode-guided PVP was proved to be safe and effective. Bilateral PVP and combined PVP can significantly and immediately abolish all Parkinsonian motor signs. Physiological methods of microelectrode recording can significantly improve the safety and efficacy of PVP, and decrease the rate of complication.