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Kích thích não sâu vùng nhân tegmental pedunculopontine: hướng tới một phương pháp phẫu thuật thần kinh lập thể mới
Tóm tắt
Việc áp dụng kích thích não sâu (DBS) vào nhân tegmental pedunculopontine (PPTg) đã yêu cầu những sửa đổi sâu sắc về các kỹ thuật phẫu thuật thần kinh cổ điển và các tiêu chí đánh giá kết quả lâm sàng. Bài tổng quan này phân tích một phương pháp mới nhằm nhắm mục tiêu đến PPTg, dựa trên chụp cắt lớp vi mạch (angio-CT) và tái xây dựng ba chiều các nhân và mạch máu não, đồng thời xem xét những lợi ích của việc áp dụng các phương pháp này so với phương pháp truyền thống hơn dựa trên các điểm tham khảo thu được thông qua việc đánh giá đường hai hội đồng. Việc xác thực các kết quả thu được sau khi kích thích đơn phương PPTg thông qua ghi nhận thần kinh sinh lý và các đo lường khách quan về các thông số chức năng cho thấy rằng PPTg có thể được coi là một đích ban đầu cho việc điều trị các triệu chứng vận động ở những bệnh nhân được chọn bị bệnh Parkinson nguyên phát (PD), mà nếu cần thiết, có thể tiếp tục kích thích não sâu ở các khu vực mục tiêu khác. Hơn nữa, dựa trên những quan sát từ việc kích thích PPTg, tính hữu dụng tiềm năng được quy cho đến nay đối với việc ghi nhận thần kinh sinh lý trong thời gian phẫu thuật để xác định các mục tiêu phẫu thuật thần kinh nên được xem xét lại, và nhu cầu thay đổi trong quản lý bệnh nhân trong thời gian phẫu thuật đã phát sinh từ khối lượng bằng chứng tích lũy trong những năm gần đây. Các kết quả thu được bởi các nhóm khác nhau sau khi kích thích DBS PPTg ở bệnh nhân Parkinson không đồng nhất, rất có thể do sự chấp nhận thận trọng phương pháp này, kinh nghiệm dần dần tích lũy, tiêu chí lựa chọn bệnh nhân và những khác biệt tinh tế trong vị trí mục tiêu. Mặc dù vai trò của PPTg trong PD và/hoặc trong các bệnh lý khác cần được làm rõ, việc theo đuổi phương pháp truyền thống với các mục tiêu hạch nền cổ điển có thể hạn chế triển vọng của DBS dựa trên nhiều cấy ghép.
Từ khóa
#Kích thích não sâu #nhân tegmental pedunculopontine #bệnh Parkinson #phẫu thuật thần kinh lập thểTài liệu tham khảo
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