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Pallidotomy: Theory and Technique

机译：苍白球切开术：理论与技术

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摘要

Pallidotomy, the surgical destruction of portions of the globus pallidus, is now frequently performed to treat patients with Parkinson's disease. As a consequence of dopamine loss in the brain of a patient with Parkinson's disease, the globus pallidus internal segment (GPi) is overactive. A lesion in the GPi compensates for this and partially alleviates most of the motor signs of Parkinson's disease, as well as levodopa-induced dyskinesias. The goal in pallidotomy is to produce a lesion of the whole sensorimotor (posterolateral) region of the GPi without producing a lesion in the external pallidum, nonmotor areas of the GPi, optic tract, or corticospinal tract. To achieve this goal, magnetic resonance imaging (MRI)-based stereotactic localization, microelectrode recording, and macrostimulation are used in concert for precise localization of the GPi and surrounding structures. Based on the known patterns of neuronal activity and receptive fields in the basal ganglia, microelectrode recording is used to construct a detailed three-dimensional map of the GPi and to identify the motor-controlling subdivision of this nucleus. Multiple microelectrode tracks, rather than a single track, are used to maximize accuracy. Pallidotomy is performed with a radiofrequency thermocoagulation probe, at multiple depths along multiple parallel tracks, to contour the lesion according to the microelectrode derived map. Precise lesion placement is important for the best long-term outcome.
机译：苍白球切开术是苍白球部分的外科手术破坏，现在经常用于治疗帕金森氏病患者。由于帕金森氏病患者大脑中多巴胺的流失，苍白球内部节段（GPi）过度活跃。 GPi中的病变可以弥补这一点，并部分缓解帕金森氏病以及左旋多巴引起的运动障碍的大多数运动症状。苍白球切开术的目标是在GPi的整个感觉运动（后外侧）区域产生病变，而在外回睑，GPi的非运动区域，视神经束或皮质脊髓束中不产生病变。为了实现此目标，基于磁共振成像（MRI）的立体定向定位，微电极记录和宏观刺激被共同用于GPi和周围结构的精确定位。基于基底神经节中神经元活动和感受野的已知模式，微电极记录可用于构建GPi的详细三维图并确定该核的运动控制区。多个微电极轨道（而不是单个轨道）用于最大化准确性。用射频热凝探针在沿着多个平行轨道的多个深度进行苍白球切开术，以根据微电极导出的图绘制病变轮廓。精确的病灶位置对于获得最佳的长期结果很重要。

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