r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2021-26-4-4-14r-n-j-194Research ArticleОБЗОРLITERATURE REVIEWХирургические методы лечения болезни ПаркинсонаSurgical treatments for Parkinson’s diseasehttps://orcid.org/0000-0002-8415-5602ТокаревА. С.TokarevA. S.

Москва

Moscow

tokarev@neurosklif.ruhttps://orcid.org/0000-0003-0521-4836РожноваЕ. Н.RozhnovaE. N.

Рожнова Елизавета Николаевна

Москва

Moscow

elizabett-eliz@yandex.ruhttps://orcid.org/0000-0001-5026-0060СинкинМ. В.SinkinM. V.

Москва

Moscow

mvsinkin@gmail.comТомскийА. А.TomskiyA. A.

Москва

Moscow

atomski@nsi.ruhttps://orcid.org/0000-0002-4534-8719РакВ. А.RakV. A.

Москва

Moscow

rak@neurosklif.ruhttps://orcid.org/0000-0003-0007-8054СтепановВ. Н.StepanovV. N.

Москва

Moscow

valentin.st534@gmail.comhttps://orcid.org/0000-0002-2221-6641ВиктороваО. А.ViktorovaO. A.

Москва

Moscow

sokolvak-5@ya.ruГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»РоссияN.V.Sklifosovsky Research Institute of Emergency MedicineRussian FederationГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»; ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова»РоссияN.V.Sklifosovsky Research Institute of Emergency Medicine; Clinical Medical Center of Moscow State University of Medicine and Dentistry n.a. A.I. EvdokimovRussian FederationФГАУ «НМИЦ нейрохирургии им. академика Н.Н. Бурденко Минздрава России»РоссияN.N. Burdenko National Medical Research Center of NeurosurgeryRussian Federation202112082021264414Copyright © Токарев А.С., Рожнова Е.Н., Синкин М.В., Томский А.А., Рак В.А., Степанов В.Н., Викторова О.А., 20212021Токарев А.С., Рожнова Е.Н., Синкин М.В., Томский А.А., Рак В.А., Степанов В.Н., Викторова О.А.Tokarev A.S., Rozhnova E.N., Sinkin M.V., Tomskiy A.A., Rak V.A., Stepanov V.N., Viktorova O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/194

Болезнь Паркинсона (БП) — это прогрессирующее неизлечимое дегенеративное заболевание центральной нервной системы, приводящее к существенному ограничению функционального состояния пациентов. Современная медицина располагает различными способами медикаментозного и хирургического лечения этого заболевания. В обзоре рассмотрены все этапы хирургического лечения БП, начиная с представляющих исторический интерес описаний резекции прецентральной извилины до стереотаксической деструкции разными способами воздействия и электрической стимуляции глубинных структур мозга. Представлены показания к каждому из методов, их преимущества и недостатки, принципы отбора пациентов. Показания для нейрохирургического лечения определяют с учетом международных критериев CAPSIT-PD. Стереотаксические деструкции приводят к необратимым изменениям мозгового вещества, поэтому их широкое использование ограниченно. Стимуляция глубинными электродами имеет преимущества при прогрессировании заболевания за счет возможности изменения параметров стимуляции и возможности двустороннего влияния на двигательные симптомы. Хирургическое лечение БП не означает отмену медикаментозной терапии, однако позволяет уменьшить дозу противопаркинсонических препаратов и их возможные нежелательные явления. Наилучший результат может быть достигнут при своевременном проведении операции и правильном отборе пациентов мультидисциплинарной врачебной бригадой с учетом особенностей течения болезни, возможности длительного послеоперационного наблюдения больного и коррекции параметров стимуляции.

Parkinson’s disease (PD) is a progressive, incurable degenerative disease of the central nervous system, leading to a significant limitation of the functional state of patients. Modern medicine has several methods of medical and surgical treatment for this pathology. In the review, all stages of the surgical treatment of PD are considered, starting with the descriptions of the resection of the precentral gyrus of historical interest to stereotaxic lesions by various methods of exposure and electrical stimulation of the deep brain structures. The indications for each of the methods, their advantages and disadvantages, the principles of patient selection are presented. Indications for neurosurgical treatment are determined taking into account the international CAPSIT-PD criteria. Stereotactic lesions lead to irreversible changes in the medulla, therefore their widespread use is limited. Stimulation with deep electrodes has advantages in disease progression due to the possibility of changing the stimulation parameters and the possibility of a bilateral effect on motor symptoms. Surgical treatment of PD does not mean the cancelling of drug therapy, but it can reduce the dose of anti-Parkinsonian drugs and reduce their side effects. The best result can be achieved with timely operation and correct selection of patients by a multidisciplinary medical team with considering the characteristics of the course of the disease, the possibility of long-term postoperative observation of the patient and correction of stimulation parameters.

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The authors declare that there are no conflicts of interest present.