Staged Bilateral Thalamus And Globus Pailidus Stereotactic Lesioning In Patients With Parkinson’s Disease:a Strategy And Efficacy Analysis

Objective To investigate the efficacy and safety of staged bilateral thalamus andglobus pallidus stereotactic lesioning of the idiopathic Parkinson’s disease (PD) andestimate it’s clinical value.Methods During February2000to February2012,19PD patients underwent stagedbilateral thalamus and globus pallidus stereotactic lesioning under the stereotacticmicroelectrode-guidance in our hospital, of which the ages, symptoms, grades,duration between two procedures, and lesioning targets were reviewed.16patientsreceived a primary procedure with ventralis intermedius nucleus (Vim) stereotacticlesioning(group1), another3had globus pallidus-internal segment(Gpi) stereotacticlesioning(group2). Second-staged contralateral Gpi and small focal of Vim nucleusstereotactic lesioning was performed on all patients. The unified Parkinson diseaserating scale(UPDRS)was used to estimate the “switch-on” and “switch-off” states ofeach patient preoperatively and1week postoperatively. Postoperative complicationsand symptomatic relief was analyed.Results Of the19patients(10male,9female),the means age was57.6years(43yr-67yr).16patients mainly presented with tremor, another3with rigidity-slowmovement. The Hoehn&Yahr grades was Ⅱ～Ⅳ.The mean durationg from the firstsurgery to the second surgery of group1and group2was43.5months(6-78months)and18months, respectively. Improvements were observed in all the19patients postoperatively in terms of stiffness and tremor, and on-off fluctuations was moderate.Stiffness was significantly alleviated after lesioning of Gpi, and tremor was markedlyrelieved after the Vim necleus small focal lesioning.17patients were followed-up.2patients had postoperative transient dysarthria, and one of them had dysphagia, whichwas disappeared after3months.Recurrence of PD symptoms assosiated withhypophrenia was obserbved in another2patients3months and12months after thesurgery.Conclusion Staged bilateral thalamus and globus pallidus stereotactic lesioning,withappropriate selection of candidates and lesioning targets, strict control of the lesioningsize,is a economic、safe and effective surgical treatment for PD patients with bilateralsevere symptoms.