Effect of the combination Pallidotomy-Subthalamotomy performed in opposite cerebral hemispheres for the treatment of motor signs in Parkinson's disease.

R de la Caridad Braña Miranda, N Ernesto Quintanal Cordero, C Nancy Pavón Fuentes, I Pedroso Ibáñez, R Macías González, C Juan Teijeiro Amador, A Abreu Duque, R Garbey Fernández
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Abstract

Introduction: Functional Neurosurgery constitutes a therapeutic alternative for patients with Parkinson's Disease (PD). It is known that both bilateral subthalamotomy and bilateral pallidotomy cause neurological complications, so in ablative techniques a bilateral approach to the GPi is not recommended in PD and caution is suggested with the indication of bilateral subthalamotomy. Our group has refined the surgical technique for the ablation of the subthalamic nucleus seeking to reduce the appearance of dyskinesias induced by surgery and obtain a better therapeutic effect, so the approach to the NST in a second surgical procedure in the opposite hemisphere to the one performed previously pallidotomy, would avoid the complications derived from bilateral pallidotomy and can be a safe alternative for patients even when they present symptoms of dyskinesias. We set out to evaluate the effect and safety of the combination of GPi and NST lesion in opposite cerebral hemispheres in PD patients.

Method: A retrospective study was carried out that included all patients operated on at the CIREN in a period of 22 years, who underwent a pallidotomy contralateral to the most affected hemibody; followed by a subthalamotomy of the opposite hemisphere in a second surgical procedure. The effect on the neurological condition was evaluated using section III of the MDS-UPDRS scale. Safety was evaluated according to the adverse effects scale and the Clavien and Dindo scale.

Results: Both surgical interventions had a positive impact on the patients' pharmacological treatment, significantly reducing the doses of L-dopa. A significant improvement was observed in the motor condition of the patients in relation to dyskinesias, as well as rigidity, bradykinesia and tremor.

Conclusions: The pallidotomy/Subthalamotomy combination showed to be an effective alternative for the treatment of complicated PD, capable of allowing better motor control and a reduction in the dose of L-Dopa with a low rate of complications; It also allows to avoid complications derived from bilateral pallidotomy and subthalamotomy, proving to be a safe alternative for patients even when they present symptoms of dyskinesias.

在对侧大脑半球进行白球切开术-丘脑下切开术联合治疗帕金森病运动体征的效果
功能神经外科是帕金森病(PD)患者的一种治疗选择。众所周知,双侧丘脑下切开术和双侧pallidotomy都会引起神经系统并发症,因此在PD的消融技术中不推荐双侧入路GPi,建议谨慎使用双侧丘脑下切开术。本小组已经改进了丘脑下核消融的手术技术,以减少手术引起的运动障碍的出现,并获得更好的治疗效果,因此,与之前进行的苍白球切开术相比,在对半球进行第二次手术进入NST,可以避免双侧苍白球切开术引起的并发症,即使患者出现运动障碍症状,也可以是一种安全的选择。我们开始评估PD患者对侧大脑半球GPi和NST病变联合治疗的效果和安全性。方法:回顾性研究纳入了22年来在CIREN手术的所有患者,这些患者在最严重的身体对侧进行了苍白球切开术;然后在第二次手术中对对半球进行丘脑下切开术。使用MDS-UPDRS量表第III节评估对神经系统状况的影响。根据不良反应量表和Clavien和Dindo量表进行安全性评价。结果:两种手术干预均对患者的药物治疗产生积极影响,显著减少左旋多巴的剂量。在与运动障碍、强直、运动迟缓和震颤相关的患者的运动状况中观察到显著的改善。结论:苍白球切开术/丘脑下切开术联合治疗复杂性帕金森病是一种有效的替代方法,能够更好地控制运动,减少左旋多巴的剂量,并发症发生率低;它还可以避免双侧苍白球切开术和丘脑下切开术引起的并发症,即使患者出现运动障碍症状,也是一种安全的选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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