A Clinical Analysis On Stereotactic Surgery Of Single Nucleus And Dual-nuclear Combined Lesion For The Patient With Advanced Parkinson’s Disease

ObjectiveBrain Stereotactic GPi or Vim single nucleus radiofrequency thermocoagulation ablation and GPi-Vim dual-nuclear combined with radiofrequency thermocoagulation ablation under CT or MRI joint resistance positioning were compared to analyze the curative effect and complications for the treatment of advanced Parkinson’s disease, to provide reference for improving the operation effectiveness and safety.Methods45patients with advanced Parkinson’s disease were firstly treated with intracranial nucleus multi-target burst frequency thermocoagulation under stereotactic positioning in unilateral cerebra.13cases of these patients were treated with unilateral Vim multiple target radiofrequency thermocoagulation ablation and8were treated with unilateral GPi multiple target radiofrequency thermocoagulation ablation. These21cases above were classified into single nucleus group;24cases were treated with GPi-Vim dual-nuclear combined with multiple target radiofrequency ablation. Hoehn&Yahr scale, UPDRS scale (Ⅱ,Ⅲ subscale), Schwab&England daily living scale, WAIS-RC, WMS-RC and HAMD scale were used to assess the two groups of patients preoperatively,1weeks after the operation,3months after the operation and6months after the operation. The postoperative fever, consciousness barrier, dysphonia, toilet disorder, limb weakness, visual field defects, intracranial hemorrhage and other complications of frequency and severity were recorded and analyzed to find the differences of operation efficacy and complications between two groups of patients.ResultsThe "on period" and "off period" of UPDRSⅡ and UPDRSⅢ, and the results of Schwab&England of two groups1weeks and3months after the operation showed no significant difference (P>0.05) by independent sample t test, but dates in6months after the operation showed significant difference (P<0.05). The results showed that the recent curative effect of dual-nuclear combined with multiple target radiofrequency ablation is the same as that of single nucleus radiofrequency thermocoagulation ablation but its long-term effect is better than that of single nuclear group. And the postoperative medication dosage for preoperative ratio of dual-nuclear group was smaller than that of single nuclear group (P<0.05). The decrease of HAMD snuclear were no statistically significant difference between two groups (P>0.05), which showed that the improvement in depressive symptoms was not a direct result of operation. Postoperative complications rate of dual-nuclear group and single nuclear group were60.8%and40.9%respectively, which showed that postoperative complications of dual-nuclear group occurred more than single nuclear group, but the questionnaire snuclear of independent samples t test in3months after the operation showed no statistical significance (P>0.05), which showed that there were no significant difference of long term complications between two groups.The WAIS-RC and WMS-RC before and after operation were not significant different (P>0.05), which showed that the two operation strategy for patients had no obvious damage on patients’ intelligence and memory. These two groups showed no obvious dead, vegetative state, severe infection, significant neurological deficit and other serious complications. The safety of these two operations are high.ConclusionThe efficacy of GPi-Vim dual-nuclear combined with multiple target radiofrequency thermocoagulation ablation is higher than that of GPi or Vim single target burst frequency thermocoagulation ablation. And it can obviously reduce drug dose of dopamine. The short-term postoperative complications occurs more in dual-nuclear group than that of single nuclear group. But it has no significant difference of long-term complications. It is better recommended to preferentially select dual-nuclear combined with multiple target radiofrequency thermocoagulation ablation if the patient is young and has better body condition.