OBJECTIVE: To investigate the method and clinical effect of stereotactic brain nucleus pulposus destruction and deep electrical stimulation in the treatment of Parkinson’s disease. METHODS: 50 patients with Parkinson’s disease underwent CT/MRI localization, combined with microelectrode recording and intraoperative measurement of impedance and electrical stimulation to determine the target points Vim, Gpi and STN, and were given destruction or implantation of electrical stimulation system for high frequency electrical stimulation treatment. RESULTS: The total effective rate was 100%, the apparent rate was 88%, and the effective rate was 12%. There were no deaths and serious complications. CONCLUSION: Stereotactic nucleus destruction and deep electrical stimulation are safe and effective in the treatment of Parkinson’s disease. Electrical stimulation has more advantages than disfiguration, but it is expensive. Keywords: Parkinson’s disease; stereotactic; radiofrequency disfigurement; deep brain electrical stimulation Parkinson’s disease is a common and frequent disease in clinical practice, which is characterized by resting tremor, muscle rigidity, reduced movement and vegetative nerve dysfunction, and is commonly seen in the middle-aged and elderly people, which seriously affects the patients’ quality of life. The authors used CT/MRI localized stereotactic radiofrequency disfiguration and deep brain electrode implantation to treat 50 cases of primary Parkinson’s disease from July 2004 to February 2011, and achieved satisfactory clinical results. It is reported as follows: 1. Data and Methods (1) General data 29 cases of male, 21 cases of female, 46 cases of Han nationality, 4 cases of Uyghur nationality. Age 50~80 years old, average 63 years old. Duration of the disease ranged from 3 to 11 years, with an average of 6 years. 42 cases had bilateral symptoms and 8 cases had unilateral symptoms. 47 cases had tremor, rigidity and bradykinesia, of which 19 cases had predominantly tremor, 10 cases had predominantly rigidity and bradykinesia, and 18 cases had a mixed type. 3 cases had only limb stiffness and bradykinesia. Four cases with depression were treated with antidepressant drugs. All cases were diagnosed by the neurology sub-specialty group of movement disorder diseases by the deputy chief physician or above, according to the diagnostic criteria established by the 1984 National Symposium on Extrapyramidal Diseases, and excluded Parkinson’s syndrome caused by other diseases, which had been systematically treated with dopamine drugs for more than 3 years. The disease was graded according to the Hoehn and Yahr grading criteria: 11 cases of grade II, 32 cases of grade III, and 7 cases of grade IV. There were 45 cases of disfiguring surgery and 5 cases of deep brain electrical stimulation (DBS). There were 30 cases of unilateral destruction of Vim nucleus, 13 cases of unilateral destruction of Gpi, and 2 cases of destruction of one side of Vim nucleus and the opposite side of Gpi nucleus. 5 cases of DBS selected thalamus substrate nucleus (STN) as the target, 3 cases of unilateral surgery, 1 case of staged bilateral surgery, and 1 case of simultaneous bilateral surgery. 45 cases of disfigurement surgery were performed, among which 26 cases were localized by CT, and 19 cases were localized by MRI (1,5T or 3,0T). 5 cases of DBS were performed by MRI. surgery were MRI localized. (2) Surgical method Stop taking dopamine drugs before surgery. Under local anesthesia, the head frame of the directional instrument was installed, and attention was paid to be parallel to the projection of AC-PC line on the body surface. CT or MRI thin-layer scanning was performed to determine the anterior coalition (AC), posterior coalition (PC) and its connecting line (IC).Vim target coordinates were set at the AC-PC level, 5~7mm anterior to the posterior coalition, 13~15mm off the median sagittal line, and adjusted appropriately according to the patient’s clinical symptoms on an individualized basis.Gpi target coordinates were taken as 2mm anterior to the midpoint of the IC, 3~6mm below the IC line, 17~21mm off the midpoint. The coordinates of STN target point were taken 2-7mm below the IC line, 0mm before the IC midpoint, and 12,5mm outside the median dystocia. The target point coordinates were calculated and then converted to head frame coordinates. Drill holes in the forehead under local anesthesia, install the directional instrument, adjust the coordinates of the target point, feed the microelectrode toward the target point with the micro-propeller through the guide needle, record the cellular electrophysiological signals from 10mm above the target point, and confirm the target point according to the results measured by the microelectrode. Replace the radiofrequency electrode, send the radiofrequency electrode to the verified target point, further verify the accuracy of the target point by electrical stimulation, no numbness of the limbs, weakness and vision field change, first give 45 ℃ for 60 seconds of reversible destruction, and after re-confirmation of the accuracy of the target point, give irreversible destruction at 75 ℃ for 60 seconds. for DBS, the same microelectrode recordings after verification of the target point, the stimulation electrode will be sent to the target point, and then the microstimulation. After observing the effect satisfactorily, general anesthesia was changed, and the electrodes, wires and pulse generators (unilateral Soleter7426, bilateral Kinter7428) were fixed one by one. Three weeks after the operation, the program control was turned on, and the parameters were adjusted according to the improvement of symptoms and the occurrence of side effects. Evaluation criteria: the complete disappearance of tremor and rigidity of the limbs was regarded as obvious effect; the obvious relief of symptoms, but still some symptoms remained was regarded as effective; no improvement of symptoms was regarded as ineffective. In this group, there were 44 cases with obvious effect (88%), 6 cases with effective effect (12%), and 0 cases with ineffective effect, the total effective rate was 100%. UPDRS score: the improvement rate of symptoms was 52% in the “on” state and 49% in the “off” state. UPDRS score: 52% improvement in the “on” state and 72% in the “off” state. Complications: 2 cases of mild hemiparesis, CT confirmed that it was caused by the edema around the target point spreading to the internal capsule, both of them recovered completely in a short period of time after treatment. 1 case of bilateral destruction showed transient dysarthria after the second operation, and recovered completely after 1 month. There were no other complications such as intracerebral hemorrhage and infection, and no deaths. Follow-up: 45 patients were followed up for 6 months to 7 years, and 8 cases with different degrees of recurrence, accounting for 17.8%. Among them, 2 cases had a gradual relapse half a year after the operation, and 6 cases had a gradual relapse 3 to 5 years after the operation. 1 case died 4 years after the operation due to other diseases. Discussion For diagnosed Parkinson’s disease patients, early should be given regular drug treatment, but with the progress of the disease, the effect of drug treatment will gradually decline. For these patients and those who are difficult to tolerate the side effects of drug therapy, it is necessary to seek active surgical treatment. Currently, stereotactic surgery for Parkinson’s disease mainly includes radiofrequency disruption and deep brain electrical stimulation. Combined with the results of our 50 cases of surgical treatment, the experience is as follows: 1, about the surgical target: it is well known that the thalamic ventral intermediate nucleus (Vim), the medial part of the globus pallidus (Gpi) and the thalamic nucleus of the thalamus (STN) are the three commonly used targets in stereotactic surgery for the treatment of Parkinson’s disease. Vim nucleus disfigurement or electrostimulation can significantly improve the tremor and rigidity of the Parkinson’s disease patient, but the effect of the symptoms of reduced locomotor movement is poor, is the treatment of predominantly tremor Parkinson’s disease. Gpi has incomplete elimination of tremor, but satisfactory results in muscle rigidity, hyperkinesia and drug-induced anisotropy. That is why many stereotactic surgeons have been interested in changing the target in recent years. This has been confirmed by our results.STN surgery not only eliminates recalcitrant tremor, relieves bradykinesia, rigidity, gait and drug-induced motor dysfunction, but also reduces postoperative dopamine dosage in some patients. At present, it is gradually and widely used in clinical especially DBS surgery. destructive surgery of STN has also been reported at home and abroad, and the effect is equally satisfactory, but we did not try it. 2, about the surgical methods: nucleus pulposus destruction and deep brain electrical stimulation are the most widely used surgical methods at present, DBS is not technically more difficult than destruction, its biggest advantage is that it does not destroy the nerve cells of the target point, it has reversible and adjustable safety, and it can be operated at the same time for both sides. However, it is still difficult to replace disfigurement surgery because of its high price. However, with the upcoming clinical application of domestic equipment and the gradual inclusion of this surgery in various insurance policies, it is believed that the clinical application of DBS surgery will become more and more widespread in the near future, and it will bring the gospel to more Parkinson’s patients. 3. Surgical efficacy and complications: Whether it is disfigurement surgery or DBS surgery, in order to achieve satisfactory clinical results and minimize the complications caused by surgery, the authors experience that: ① Strictly mastering the indications for surgery is an important factor to improve the efficacy of surgery. All of our surgical patients were diagnosed by the neurologist specializing in movement disorder diseases, and were treated with regular internal medicine to strictly control the diagnosis of the disease. ② Precise positioning during surgery is the key to success. If possible, microelectrode recording technology is used to ensure the accuracy of the target point, improve the efficacy and reduce the occurrence of complications. ③ It is very necessary to continue to take medication and reasonable exercise and rehabilitation after surgery. At present, there is no cure for the disease, and surgery can only relieve symptoms, slow down the progress of the disease and improve the quality of life of patients. Therefore, it is necessary to continue to take medication after the operation, and carry out active physical exercise and various rehabilitation training.