Long-term Results of Ventrolateral Thalamotomy for Patients with Parkinson's Disease

過去20年間にVL. thalamotomy で治療した Parkinson病(PD)患者53名の治療成績を分祈した。一側手術例44例では、振戦、筋強剛に対する効果は良好で、平均8.8年の追跡期間中効果が持続していた。無動に対しては効果は乏しく、その進行が ADL低下の主因であった。両側手術例 9例でも同様の傾向で、無動の顕著でない例は長期間良好なADLが維持されていた。重大な合併症は、凝固部位の脳内血腫1例、軽度なものは、一過性麻痺4例、一過性意識障害2例、けいれん発作2例であった。振戦、筋強剛がADL低下の主な原因となっているPD患者は thalamotomy の良い適応であり、他の治療法と組み合わせることによりPD患者の治療予後改善に役立つと考えられた。

This study evaluated the long-term outcome for 53 patients with idiopathic Parkinson's disease treated by stereotactic thalamotomy between 1977 and 1996 at our institute. Significant reduction of tremor and rigidity of the contralateral extremities persisted throughout the follow-up period (mean 8.8 years) in 44 patients who underwent unilateral thalamotomy. These effects resulted in postoperative improvement of activity of daily life (ADL) with reduced dosage of levodopa. The effect of surgery on akinesia was limited and postoperative progression of akinesia was related to the postoperative deterioration of ADL. Multivariate analysis disclosed that the preoperative akinesia score was the critical factor for poor outcome. Nine patients underwent bilateral thalamotomies at a mean interval of 56 months. Five patients were obviously benefited from the second thalamotomy. The only perioperative complication was large intracerebral hematoma at the lesion site in one patient. This study confirmed the reliable and persistent effect of thalamotomy. Patients with Parkinson's disease whose disability is mainly caused by tremor and/or rigidity will be benefited from this procedure. Second thalamotomy, contralateral to the initial side, may be indicated if the ADL deteriorates due to the progression of the symptoms on the non-treated side. Patients disabled by advanced akinesia are not good candidates for thalamotomy.