微电极导向立体定向手术治疗舞蹈病  

Treatment of Huntington's disease with microelectrode guide stereotactic radiofrequency

作　　者：李智勇[1] 梁国标[1] 杜鹏[1] 唐新华[1] 陈游力[1] 魏学忠[1] 

机构地区：[1]沈阳军区总医院神经外科,辽宁沈阳110016

出　　处：《中华神经外科疾病研究杂志》2004年第5期417-419,共3页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的　探讨微电极导向立体定向多靶点毁损治疗慢性进行性舞蹈病 (HD)。方法　选择丘脑腹外侧核 (VL) ,苍白球内侧 (Gpi)及Forel H区为毁损靶点 ,治疗 7例 (8侧 )HD患者。结果　双侧手术后的患者 ,经随访 34个月表明 ,患者除有一侧颈部肌群偶发不自主运动外 ,恢复了独立生活能力。其余单侧手术治疗后患者中 ,除 1例外 ,治疗对侧肢体症状基本消失 ,躯干和面部症状明显好转 ,生活质量提高。结论　HDγ 氨基丁酸 (GABA)传递功能降低 ,破坏基底节 皮质环路。毁损VL和Forel H区 ,主要针对舞蹈样动作治疗。而毁损Gpi对患者出现的肢体活动笨拙 ,肌张力改变治疗有效。术中微电极检测是重要的环节 ,在VL检测中 ,发现了同患者异常运动一致的间歇性脉冲样高频神经放电 ,对这些点标记并毁损 ,疗效很好。Gpi毁损范围靠近苍白球外侧。对于HD术前和术后判定量性指标 。Objective To discuss the treatment of Huntington`s disease (HD) by stereotactic multi target radiofrequency derogation.Methods 7 patients (8 unilateral sides) were selected. The different radiofrequency targets were chosen, such as ventral lateral nucleus (VL), globus pallidus internus (Gpi) and Forel H zone. Results The patients who underwent operation of bilateral operation were investigated 34 months after operation. The patients could live independently except occasional involuntarily movement of cervical muscles . After unilateral operation, the patients' symptoms of opposite limb disappeared, the symptoms of face and body got better and the quality of life was improved.Conclusion The number of neurons in caudate nucleus and putamen decreases and the fraction of γ aminobutyric acid (γ GABA) reduces, which destroys the basal ganglia cortex loop. Derogation of ventral lateral nucleus (VL) and Forel H zone is the main purpose in the treatment of hyperkinesias , and the derogation of globus pallidus internus (Gpi) is effective in treating akinesia and relieving muscular tension. It is important to use the microelectrode in the operation. During the checking of ventral lateral nucleus (VL) target, the authors find that high frequency neural discharge is consistent with the patients' abnormal movements. Satisfactory effects can be achieved by derogating these targets. The range of globus pallidus internus (Gpi) is near the lateral globus pallidus. The authors also bring forward their standard of quantification for Huntington's disease (HD) pre and post operation.

关 键 词：微电极导向 立体定向手术 舞蹈病 HDγ-氨基丁酸 苍白球内侧 丘脑腹外侧核 

分 类 号：R742.2[医药卫生—神经病学与精神病学] R454.1[医药卫生—临床医学]