Clinical application of stereotactic surgery for Parkinson disease

Objective:To summarize the experience on clinical application of microelectrode-guided stereotactic pallidotomy or thalamotomy and deep brain stimulation for treatment of Parkinson disease.Methods: Five hundred and ten patients with Parkinson disease underwent pallidotomy or thalamotomy and 62 received deep brain stimulation from Apr. 1999 to Apr. 2004. Of these patients, 385 underwent unilateral pallidotomy, 10 underwent bilateral pallidotomy, 91 underwent thalamotomy, 12 underwent pallidotomy and thalamotomy,8 underwent staged pallidotomy or thalamotomy,4 underwent staged unilateral pallidotomy and contralateral thalamotomy.Sixty-one patients with Parkinson disease were treated with subthalamic nucleus(STN) stimulation and 1 patient with ventralis intermedius nucleus (Vim) stimulation;thirty-one cases received bilateral stimulation of subthalamic nucleus and the other 31 cases received unilateral stimulation. The UPDRS scale was used to assess patients in “on”- and “off” -drug conditions before and after surgery. Results: The UPDRS motor scale improved by 45.2% under “on”-drug conditions by 25.7% under “off”-drug conditions after operation in pallidotomy group. The mean follow-up was 11.6 months in 220 cases. Excellent results were observed in 130(59.9%) cases, good results in 75(34%) cases,and ineffective in 15(6.8%) cases. In DBS group, UPDS motor scores improved by 45.2% when the stimulation was turned on and by 25.7% when the stimulation was turned off. In 62 patients with a mean follow-up of 11.8 months, 12 cases had their stimulation parameters adjusted within 1 month and 40 cases need no adjustment.Conclusion: The different intracranial target should be chosen according to symptoms of the patients when performing pallidotomy or thalamotomy.DBS has less complications and has become an important treatment for Parkinson disease.