VL (ventral lateral thalamic nucleus), PVP (posterior ventral pallidum), and STN (basal thalamic nucleus) are the three targets for surgical treatment of Parkinson’s disease (PD), and either or both are chosen depending on the patient’s clinical presentation. The choice of surgical site in clinical practice is based on the patient’s specific situation, such as age, the main cause of the dysfunction, the efficacy of medications, and the patient’s own wishes. Symptoms for which disruption is effective DBS is also effective, and vice versa.
Relationship between intracerebral treatment targets and typical clinical symptoms of PD
Surgical targets
tremor
rigidity
slow movement
Heterokinesia
gait
rigidity
VL
++++
++
-
++
-
-
PVP
+++
++
++
++++
+
-
STN
++++
+++
+++
+++
++
+
1.VL is suitable for
(1) Those with predominantly tremor, especially those with postural or motor tremor or resting tremor for which drug therapy is ineffective, which affects the ability to live and work;
②Unilateral symptoms are heavy, without obvious slow movement;
③Levodopa-like drug-induced allodynia.
2.PVP is suitable for
①Primary PD;
②After systematic drug treatment, there is clear efficacy, but the efficacy is progressively decreasing, and side effects such as symptom fluctuation or heterokinesia appear;
③Hohen}Yahr “off” status grade III or above;
④People who can cooperate well with the doctor during the operation.
3.STN is suitable for
①Patients with primary PD who are taking levodopa preparations with reduced efficacy or side effects;
②Patients who have obvious difficulty in starting or stiff step;
③Patients with high dosage of levodopa drugs, more than 1000mg per day;
④Patients whose PD symptoms are aggravated in the contralateral limb after pallidum destruction (dissection) on one side.