画像診断により視床腹外側核の破壊が確認されたパーキンソン病手術例の手術成績 : 術後10年以上の長期追跡調査結果について

This paper presents a long-term follow-up study of 107 patients with Parkinson disease (PD) who underwent unilateral or bilateral image verified ventrolateral (VL) thalamotomy in our service between June 1976 and December 1982. Of these 107 patients, 101 received unilateral surgery, and six bilateral surgery. The follow-up periods were at least 10 years from the operation (from the second intervention in cases with bilateral procedures).
In 101 cases (48 males and 53 females) who received unilateral surgery, the mean age at onset was 54.2 years, the mean age at the time of the operation was 59.0 years and the average duration from the onset of the disease to the operation was 4.46 years. Thirty-nine of 101 patients died within 10 years after the operation, but 18 patients died from illnesses unrelated to their PD : five cases with cancer, four with heart failure, three with trauma (not related to PD), two with apoplexy, two with sudden death, one with ileus and one in a traffic accident, respectively. The other 21 patients were thought to have died from the progression of PD.
In the remaining 83 cases of the unilateral group, except 18 patients who died from illnesses unrelated to their PD, there was no progression after surgery in two of five patients classified preoperatively in Grade I , 20 of 44 patients in Grade II a, 15 of 23 patients in Grade IIb and three of 11 patients in Grade III.
In six cases (three males and three females) who received bilateral surgery, the mean age at onset was 38.8 years, the mean age at the first surgical procedure was 44.2 years and the average duration from the onset of the disease to the first operation was 5.33 years. The average interval between the first and second operations was 4.97 years and the mean age at the second surgical procedure was 49.0 years. Before the first operation, one patient was graded as Grade I, two as Grade IIa and three as Grade IIb. Before the second operation, these cases were classified as five in Grade IIa and one in Grade IIb. Ten years after the second operation, there was no noticeable progression of the disease in two of six patients, but five of six patients had been in the same condition for nearly 15 years from the time of the first operation, and no patient died.
The older-onset cases (onset at 60 years of age or more) tended to show more rapid progression of the PD. However, there was the same improvement in all cases in the early postoperative stage, but the long-term result of the older-onset cases was worse than that of the younger-onset cases (onset at less than 60 years of age). At the early postoperative stage, Grade III patients demonstrated the same surgical effect as Grade I to IIb patient. However the long-term result of Grade III was not so good as that of Grade I to IIb. Prognosis in the patients who had received L-DOPA therapy preoperatively was worse than that of patients who had no L-DOPA therapy.
VL thalamotomy is effective for improving the motor symptoms of PD and activity of daily living of PD patients, but from our data, indication of surgery should thus be determined carefully in the group of older-onset cases, Grade III cases and L-DOPA treated patients.