From May, 2000 to June, 2001, 27 patients with Parkinson disease (PD), including 10 cases of rigidity, 13 cases of tremor, 4 cases of rigidity and tremor, were treated by microelectrode-guided technique. Among them, phlebotomy was carried out in 17 cases and thalamotomy in 10 cases. All the targets of lesion were anatomically located by using MR and neurophysiological signals on microelectrode. Our results showed that the efficiency of microelectrode-guided technique for treatment of PD was 98%. The postoperative unified parkinson disease rating scale were 12.3 +/- 9.1 and 13.2 +/- 8.9 respectively, which significantly improved as compared with those before operation. It was concluded that by recognizing special electrical signals in neurons microelectrode-guided neuropsychological techniques can locate target at cellular level, which overcomes the individual difference in anatomy and function, and allow more accuracy, safety and efficiency of operation. This is especially true of PD patients who fail to respond to medical treatment.
Magnetic Resonance Imaging ; *Microelectrodes ; Parkinson Disease/*surgery ; Stereotaxic Techniques ; Thalamus/surgery

From May, 2000 to June, 2001, 27 patients with Parkinson disease (PD), including 10 cases of rigidity, 13 cases of tremor, 4 cases of rigidity and tremor, were treated by microelectrode-guided technique. Among them, phlebotomy was carried out in 17 cases and thalamotomy in 10 cases. All the targets of lesion were anatomically located by using MR and neurophysiological signals on microelectrode. Our results showed that the efficiency of microelectrode-guided technique for treatment of PD was 98%. The postoperative unified parkinson disease rating scale were 12.3 +/- 9.1 and 13.2 +/- 8.9 respectively, which significantly improved as compared with those before operation. It was concluded that by recognizing special electrical signals in neurons microelectrode-guided neuropsychological techniques can locate target at cellular level, which overcomes the individual difference in anatomy and function, and allow more accuracy, safety and efficiency of operation. This is especially true of PD patients who fail to respond to medical treatment.
Adult ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Microelectrodes ; Middle Aged ; Parkinson Disease ; surgery ; Stereotaxic Techniques ; Thalamus ; surgery

OBJECTIVETo investigate the relationship between limb tremor and neuronal firing in thalamus (Vim) and retrospectively review the clinical effects and safety of the surgical treatment of essential tremor (ET).

METHODSForty-two ET patients received microelectrode-guided thalamotomy and 11 cases were quantitatively evaluated with FAHN rating scales pre- and post-operatively.

RESULTSThere were electrophysiological tremor-related neurons in ventrolateral part of thalamus. Lesioning of those neurons abolished contralateral limb tremor in all of the patients. No permanent contralateral weakness, dysarthria and hemorrhage were observed.

CONCLUSION"Tremor cell" in thalamus plays a key role in the symptom of ET patients. Destruction of those cells may completely and permanently abolish tremor symptom.

Adult ; Aged ; Aged, 80 and over ; Electrophysiology ; Essential Tremor ; physiopathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neurons ; physiology ; Retrospective Studies ; Thalamus ; physiopathology ; surgery

OBJECTIVETo summarize the clinical characteristic and radiotherapeutic effect of germinomas arising in basal ganglia and thalamus.

METHODSThe clinical data of 13 cases were reviewed retrospectively. All cases were pathologic diagnosis through stereotactic biopsy. Gamma-knife or ordinary irradiation were 2 cases respectively and the combined therapy with interstitial brachytherapy as foundation were 9 cases.

RESULTAll cases were male, median age of 16.1 years. Hemiparesis and ataxia were major symptoms, some cases were accompanied with precocious puberty. Imaging manifested intratumoral cystic components represented 76.9% of all lesions, calcification represented 30.8%, ipsilateral cerebral and brain stem hemiatrophy represented 46.2%, cerebral white matter invasion through internal capsule or corpus callosum represented 30.8%. One case died because of late complication and 12 cases had achieved satisfied therapeutic effect (the mean followed-up period was 40.6 months). Tumor-control were effective.

CONCLUSIONSThe clinical manifestation and imaging characteristics are helpful to diagnosis. Stereotactic biopsy make the affirmatory diagnosis. Operative total-removal is impossible because of deep location, neighbour of vital structure and invasion. The combined therapy with interstitial brachytherapy was effective.

Adolescent ; Adult ; Basal Ganglia ; Brain Neoplasms ; diagnosis ; radiotherapy ; surgery ; Child ; Follow-Up Studies ; Germinoma ; diagnosis ; radiotherapy ; surgery ; Humans ; Male ; Retrospective Studies ; Thalamus ; Treatment Outcome

Adolescent ; Adult ; Astrocytoma ; diagnosis ; surgery ; Brain Neoplasms ; diagnosis ; surgery ; Child ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Microsurgery ; methods ; Middle Aged ; Thalamic Diseases ; diagnosis ; surgery ; Thalamus ; surgery ; Treatment Outcome

OBJECTIVE: To determine, using proton magnetic resonance spectroscopy (1H MRS) whether thalamotomy in patients with Parkinson's disease gives rise to significant changes in regional brain metabolism. MATERIALS AND METHODS: Fifteen patients each underwent stereotactic thalamotomy for the control of medically refractory parkinsonian tremor. Single-voxel 1H MRS was performed on a 1.5T unit using a STEAM sequence (TR/TM/TE, 2000/14/20 msec), and spectra were obtained from substantia nigra, thalamus and putamen areas, with volumes of interest of 7-8ml, before and after thalamotomy. NAA/Cho, NAA/Cr and Cho/Cr metabolite ratios were calculated from relative peak area measurements, and any changes were recorded and assessed. RESULTS: In the substantia nigra and thalamus, NAA/Cho ratios were generally low. In the substantia nigra of 80% of patients (12/15) who showed clinical improvement, decreased NAA/Cho ratios were observed in selected voxels after thalamic surgery (p < 0.05). In the thalamus of 67% of such patients (10/15), significant decreases were also noted (p < 0.05). CONCLUSION: Our results suggest that the NAA/Cho ratio may be a valuable criterion for the evaluation of Parkinson's disease patients who show clinical improvement following surgery. By highlighting variations in this ratio, 1H MRS may help lead to a better understanding of the pathophysiologic processes occurring in those with Parkinson's disease.
Adult ; Aged ; Aspartic Acid/*analogs & derivatives/metabolism ; Brain/*metabolism/pathology ; Choline/metabolism ; Female ; Human ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Male ; Middle Age ; Parkinson Disease/*metabolism/pathology/*surgery ; Protons ; Putamen/metabolism/pathology ; Substantia Nigra/metabolism/pathology ; Thalamus/*metabolism/pathology/*surgery