What Is a Pallidotomy?

Pale globules are located on the bean-shaped nucleus of the striatum and are an important part of them. Pale globules contain more myelin fibers and their nerve cells are larger.

Pale globules are located on the bean-shaped nucleus of the striatum and are an important part of them. Pale globules contain more myelin fibers and their nerve cells are larger.

Chinese name

Pale ball

Foreign name

globus pallidum

Pale Ball Overview

1. Striatum:

The striatum is one of the main neural structures of the extrapyramidal motor system. Including bean-shaped nucleus and caudate nucleus. The former is divided into shells and pale balls. In terms of occurrence and fiber connection, the caudate nucleus and shell belong to the neostriatum, and the pale globus belongs to the old striatum. The head of the bean-shaped nucleus and the caudate nucleus are connected. There are nerve fibers at the junction and inside the bean-shaped nucleus to form gray and white stripes. This form is very clear on the horizontal section of the middle hemisphere. The caudate and bean-shaped nuclei are called striatum.

The striatum is generally regarded as an important relay nucleus of the descending conduction beam of the cerebral cortex. Its functions are: maintaining normal muscle tension; maintaining muscle group coordination and relative stability during muscle movement. Clinically, the symptoms and signs of striatum can be classified into two types. A type of muscular dysfunction disorder, mostly manifested as increased muscle tension caused by slowness of movement, too little facial expression (mask face). Another type of dyskinesia often involves involuntary movements, such as tremors, hand and foot movements, and chorea. Such movements tend to increase when emotionally agitated, and disappear when sleeping peacefully.

2. Caudate nucleus:

The caudate nucleus is part of the striatum. It is horseshoe-shaped with the full length of the lateral ventricle. The anterior part of the caudate nucleus is enlarged, called the caudate nucleus. The caudate nucleus is slightly thinner in the middle, called the caudate nucleus, which extends along the dorsal lateral edge of the thalamus with the terminal line as the boundary between them. To the back of the thalamus, the caudate nucleus is thinner, called the caudate nucleus. It flexes towards the ventral side, advancing on top of the inferior corner of the lateral ventricle, connecting the amygdala. This nucleus is part of the extrapyramidal system. If the caudate nucleus is damaged, muscle tension may decrease and excessive exercise may occur too quickly.

Anatomy of a pale sphere:

1. Caudate nucleus:

The caudate nucleus belongs to the basal nucleus and is an arcuate rod-shaped gray matter mass, all attached to the lateral ventricle. Its front end is hypertrophic, called the caudate nucleus, which protrudes into the anterior horn of the lateral ventricle to form the outer wall of the anterior horn; the front part of the head is connected to the anterior perforator. The ventrolateral part is connected to the lenticular nucleus. It gradually tapers backward from the caudate nucleus to form a caudate nucleus. Its tail runs backward along the dorsal lateral margin of the thalamus, then bends down, and then forwards along the top wall of the inferior corner of the lateral ventricle, reaching the front end of the inferior corner and ending in the amygdala.

The caudate nucleus and the bean-shaped nucleus have the same structure of the putamen, and are mainly composed of spindle-shaped or round small nerve cells, and there are some multi-maximal nerve cells scattered there. They appear later in germline and are called neostriatum. Pale globules contain more myelin fibers and their nerve cells are larger. Appears in germline, so it is called old striatum.

Pale ball Parkinson's disease

Overview: Historically, pale bulbotomy has been used to treat many types of dyskinesias. Nowadays this surgery is mainly used to treat primary Parkinson's disease. Other data indicate that for partial dystonia and sideways throwing Disease also helps. Parkinson's disease can be divided into tremor-based and muscle stiffness-dyskinesia based on its symptoms. The latter is characterized by muscle stiffness-dyskinesia, unstable posture and gait disorders. Many patients are accompanied by dementia and the disease progresses rapidly, which is suitable for pale bulbotomy.

Indications

1. Patients with clinically diagnosed primary Parkinson's disease have a good drug response.

2. In the "off" state, Hoehn and Yahr are graded or higher.

3. Severe motion fluctuations (on-off phenomenon, dyskinesia, rigidity) are difficult to control.

4. Despite the administration of various anti-Parkinson's drugs, the clinical response is poor.

Contraindications

1. Severe dementia or depression.

2. Severe systemic diseases may increase the complications of surgery, such as severe heart and lung disease, diabetes, and uncontrollable hypertension; severe swallowing difficulties.

3. Severe dementia or depression.

4. The patient's symptoms of Parkinson's disease have evidence secondary to other diseases, or atypical Parkinson's syndrome: have a history of stroke, drug poisoning, encephalitis, taking antipsychotics, etc .; have motor neurons and Evidence of cerebellar damage, pseudobulbar paralysis, orthostatic hypotension; MR suggests Parkinson's syndrome, such as lacunar infarction, axillary and cerebellar atrophy.

The above indications and contraindications are only a guiding principle. Some patients do not fully meet the above criteria, but because the symptoms of Parkinson's disease significantly affect their daily lives, pallotomy is also feasible.

4. Pale sphere related diseases:

Pale globular nigra degeneration:

Autosomal recessive disease, symmetrical degeneration of pale globules and nigra, nerve cells have iron pigment deposits and waxy lipofuscin and neuromelanin deposits. Bone marrow tissue has aquamarine histiocytes. Onset is mostly under 10 years of age, clinically has progressive extrapyramidal dyskinesia and mental decline. Fundus retinal pigment degeneration can be seen. The course of the disease progresses slowly and the prognosis is poor. Late language disappears, eventually leading to dementia. CT and MRI showed brain atrophy and lesions (indicating iron deposition) in the basal ganglia (especially pale bulbs). Systemic iron metabolism is normal. No special treatment.