Background: There is a long history, beginning in the 1940s, of ablative neurosurgery on the pallidal efferent fibers to treat patients suffering from Parkinson's disease (PD). Since the early 1990s, we undertook a re-actualization of the approach to the subthalamic region, and proposed, on a histological basis, to target specifically the pallidothalamic tract at the level of Forel's field H1. This intervention, the pallidothalamic tractotomy (PTT), has been performed since 2011 using the MR-guided focused ultrasound (MRgFUS) technique. A reappraisal of the histology of the pallidothalamic tract was combined recently with an optimization of our lesioning strategy using thermal dose control. Objective: This study was aimed at demonstrating the efficacy and risk profile of MRgFUS PTT against chronic therapy-resistant PD. Methods: This consecutive case series reflects our current treatment routine and was collected between 2017 and 2018. Fifty-two interventions in 47 patients were included. Fifteen patients received bilateral PTT. The median follow-up was 12 months. Results: The Unified Parkinson's Disease Rating Scale (UPDRS) off-medication postoperative score was compared to the baseline on-medication score and revealed percentage reductions of the mean of 84% for tremor, 70% for rigidity, and 73% for distal hypobradykinesia, all values given for the treated side. Axial items (for voice, trunk and gait) were not significantly improved. PTT achieved 100% suppression of on-medication dyskinesias as well as reduction in pain (p < 0.001), dystonia (p < 0.001) and REM sleep disorders (p < 0.01). Reduction of the mean L-Dopa intake was 55%. Patients reported an 88% mean tremor relief and 82% mean global symptom relief on the operated side and 69% mean global symptom improvement for the whole body. There was no significant change of cognitive functions. The small group of bilateral PTTs at 1 year follow-up shows similar results as compared to unilateral PTTs but does not allow to draw firm conclusions at this point. Conclusion: MRgFUS PTT was shown to be a safe and effective intervention for PD patients, addressing all symptoms, with varying effectiveness. We discuss the need to integrate the preoperative state of the thalamocortical network as well as the psycho-emotional dimension.

中文翻译：

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MRgFUS睑缘膜全切开术治疗51例连续患者的耐慢性帕金森氏病：单中心经验。

背景：从1940年代开始，在苍白神经传出纤维上进行消融神经外科手术治疗帕金森氏病（PD）的患者已有悠久的历史。自1990年代初以来，我们对丘脑下区域的方法进行了重新设计，并在组织学基础上提出了在福尔勒（Forel）场H1的水平特别针对苍白丘脑的目标。自2011年以来，已使用MR引导的聚焦超声（MRgFUS）技术进行了这种方法，即睑缘丘脑切开术（PTT）。最近重新评估了苍白丘脑通道的组织学，并使用热剂量控制优化了我们的损伤策略。目的：本研究旨在证明MRgFUS PTT对慢性耐药PD的疗效和风险特征。方法：该连续病例系列反映了我们目前的治疗常规，收集于2017年至2018年。其中包括47例患者的52项干预措施。15例患者接受了双侧PTT。中位随访时间为12个月。结果：比较了统一的帕金森氏病评分量表（UPDRS）术后用药得分与基线用药得分，发现震颤的平均百分比降低了84％，僵硬的平均降低了70％，远端运动迟缓的平均降低了73％，为治疗侧给出的所有值。轴向项目（用于语音，躯干和步态）没有明显改善。PTT实现了100％的药物治疗型运动障碍抑制以及疼痛减轻（p <0.001），肌张力障碍（p <0.001）和REM睡眠障碍（p <0.01）。平均左旋多巴摄入量减少了55％。患者报告手术侧平均震颤减轻88％，全身症状平均减轻82％，全身总体症状改善69％。认知功能无明显变化。与单侧PTT相比，一小部分的双边PTT在一年的随访中显示出相似的结果，但目前尚不能得出明确的结论。结论：MRgFUS PTT被证明是对PD患者的一种安全有效的干预措施，可解决所有症状，且疗效各异。我们讨论了整合丘脑皮质网络的术前状态以及心理情感维度的必要性。与单侧PTT相比，一小部分的双边PTT在一年的随访中显示出相似的结果，但目前尚不能得出明确的结论。结论：MRgFUS PTT被证明是对PD患者的一种安全有效的干预措施，可解决所有症状，且疗效各异。我们讨论了整合丘脑皮质网络的术前状态以及心理情绪维度的必要性。与单侧PTT相比，一小部分的双边PTT在一年的随访中显示出相似的结果，但目前尚不能得出明确的结论。结论：MRgFUS PTT被证明是对PD患者的一种安全有效的干预措施，可解决所有症状，且疗效各异。我们讨论了整合丘脑皮质网络的术前状态以及心理情感维度的必要性。