Neurological Surgery 脳神経外科46巻9号

2018年09月発行

総説

脳深部刺激療法の精度を向上させる工夫と実践

著者： 佐々木達也¹ 上利崇² 伊達勲¹

所属機関： ¹岡山大学大学院医歯薬学総合研究科脳神経外科 ²倉敷平成病院脳神経外科

ページ範囲：P.751 - P.762

Ⅰ．はじめに
　薬物治療に抵抗性を示す不随意運動症に対して脳深部刺激療法（deep brain stimulation：DBS）は有効である．主な適応疾患はパーキンソン病（Parkinson's disease：PD），本態性振戦（essential tremor：ET），ジストニアであり，標的は視床下核（subthalamic nucleus：STN），淡蒼球内節（internal segment of the globus pallidus：GPi），視床中間腹側核（nucleus ventralis intermedius of the thalamus：Vim）などに設定される．一般的に，PDに対してはSTNやGPiが，全身性ジストニアに対してはGPiが，ETや振戦優位のPD，局所性ジストニアに対してはVimがそれぞれ標的とされる．DBSを成功させるためには，診断を含めた術前評価を綿密に行い，手術適応を誤らないこと，安全で精確な手術を行うこと，術後適切に刺激調節を行うことが重要である．一連の手技を，各ステップにあるピットフォールを理解しながら，精確に行うことは容易ではない．手術症例を蓄積することで経験的に学ぶことも多いが，機能的脳神経外科では，初回の手術から臨床症状の改善が求められることを念頭において手術に臨むべきである．本稿では手術精度を向上させるために，当科で行っている実際の手術手技について具体的に述べる．

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