Author/Editor		Ostertag, Ch B
Title		Surgical treatment of Parkinsons's disease
Translated title		Kirurško zdravljenje Parkinsonove bolezni
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 65, št. Suppl 3
Publication year		1996
Volume		str. III-93-6
Language		eng
Abstract		After two decades of drug treatment of Parkinson's disease it is evident that L-dopa and other drugs can not control tremor in a minority of patients. Thus surgical approaches are making a comeback particularly for patients with intractable tremor. There are 5 options: transplantation of adrenal/fetal or engineered cells to be implanted into the corpus striatum, destructive lesions in the lateral thalamus or medial globus pallidus and chronic stimulation with deep brain electrodes. Whereas transplantation of tissue still is in an investigation phase, destructive thalamotomy/pallidotomy is the operation of choice. For patients with biliteral tremor chronic stimulation for one side and a destructive lesion for the other side is a treatment option. However, the lack of consensus on target selection and treatment selection is evident. The risk and success rates of the two procedures are similar. Chronic stimulation has the advantage that stimulation-induced complications are reversible, which is not the case with destructive surgery. A disadvantage which counterbalances the benefits of stimulation is the nuisance that the patient has to take care of functioning stimulator for the rest of his/her life. Apart from controlling the tremor stereotactic postero-ventral pallidotomy may also be beneficial for bradykinesia. So far it is unsertain how long-term results of pallidotomy will compare with those of thalamotomy. The current status of surgical approaches for Parkinson's disease is discussed including physiologic monitoring and the personal preferences.
Summary		Po več kot dveh desetletjih uporabe levodope je očitno, da pri nekaterih bolnikih to zdravilo ne more odpraviti tremorja. Kirurške tehnike - zlasti za zdravljenje hudega tremorja - se zato znova uveljavljajo. Obstaja pet možnosti: implantacija adrenalnih/fetalnih ali umetno proizvedenih celic v korpus striatum, destruktivne lezije v področju lateralnega talamusa ali medialnega globusa palidusa in kronična stimulacija z intracerebralnimi elektrodami. Presajanje tkiv je še vedno v raziskovalni fazi, destruktivna talamotomija/palidotomija pa je že uveljavljeno operativno zdravljenje. Pri bolnikih z obojestranskim tremorjem se lahko odločimo za kronično stimulacijo na eni strani in destruktivni poseg na drugi. Čeprav še vedno ni pravega soglasja o izboru zdravljenja in mesta operativne lezije, pa so tveganja in ugodni izidi obeh tehnik primerljivi. Prednost kronične stimulacije je, da so morebitni zapleti reverzibilni, slaba stran pa, da mora bolnik do konca življenja skrbeti za delovanje stimulatorja. Stereotaktična posteroventralna palidotomija lahko pomaga tudi pri hudi bradikinezi. Še vedno ni jasno, kako bodo dolgoročni učinki palidotomije primerljivi z učinki talamotomije. V članku podajam pregled sodobnih kiruških pristopov pri Parkinsonovi bolezni, vključno s fiziološkim nadzorovanjem in osebnimi izbori tehnik.
Descriptors		PARKINSON DISEASE THALAMUS GLOBUS PALLIDUS BRAIN TISSUE TRANSPLANTATION