A Clinical Study Of The Electric Activities And The Anatomic Characteristics On The Neural Cess With Globus Pallidus Internus

Surgical treatment is a necessary means to handle parkinson's disease(PD). At present, PVP(posteroventral pallidotomy) is one of the most frequently used and effective operative method. Recently, with the improvement of electrophysiological technique and instrument, micro- electrode recording of physio-electricity potential of nucleus, such as globus pallidus, thalamus, STN, can provide cellular grade information for functional localization in surgical procedure. It is a pretty supplement and improvement of traditional anatomic localization by means of imageology. Identification the role of microelectrode, and the method of utilizing microelectrode recording during the operation for PD, still kept confused and even wrong. First part of the study focused on analyzing the target point Gpi's physio-property by pallidurn physio-electricity recording in Parkinsonian patients. A new theory titled effective pathway?was put forward. The localizing method guided by the new theory was easy to manipulate in clinical practice. In the second part of the study probed a combination operative project (thalamotomy and pallidotomy) to make up the PVP operation's deficiency of leaving behind extremities tremor after PVP treatment in Parkinsonian patients. Part one: One hundred and twenty cases had been analyzed in detail of 487 patients with PD who underwent pallidotomy with the help of microelectrode guided technique. The following results were got. 1. Mieroelectrode recording provided the anatomic information for surgical treatment through the potential of Gpe,Gpi and optic tract in different frequency. 2. The correlative cinesi-cells involved in Gpi distribute in some regular. Lower extremity motor neurons lie in the dorsum of Gpi, the correlative motor neurons of face and masticatory muscles in the ,optimal ventral of Gpi, .4. and tipper extremity motor neurons in its internal. The rule provide the information for treating the involved extremities. 3. There were almost 30% multi-response neurons in the correlative motor neurons of Gpi. It. suggest that the physio-electricity of Gpi were excessively excitatory, and neuron cells and their dendrites were in abnormal generalization status. 4. Microelectrode recording in Gpi effectively provided the physio- electricity signal of Gpe, Gpi and optic tract. A new theory titled "effective pathway" was produced for localization the target point according to these findings. It is superior to the used method that localize the physio-interspace or the margin of Gpi by multi-bullet pathway and multi-incisions. The new methods' clinical procedure is easy to operate, and therefore it could be extended and utilized more easily for treating Parkinson disease. Part two: It was well-known that the traditional thalamotomy had been generally accepted superiority to completely control the tremor of PD, although, had no effect or poor effect to bradykinesia and drug-induced movement disorders. Failed in controlling the tremor of PD still was the remarkable deficiency of PVP. The ipsilateral thalamotomy was extremely efficacious for 97 Parkinsonian patients with tremor after PVP. In this part, focused on studying the combination operative style of thalamotorny and pallidotomy by measuring the correlative data of globus pallidus, thalamus and internal capsule during operation in terms of three dimension reconstruction in multimedia and magnetic resonance workstati...