Parkinson’s disease (PD), a chronic neurodegenerative disorder, manifests with symptoms like tremors, rigidity, and bradykinesia. While levodopa initially alleviates symptoms, its efficacy diminishes over time, often causing severe side effects. Posteroventral pallidotomy (PVP) emerges as a surgical solution by targeting the overactive globus pallidus internus (GPi), which inhibits motor thalamus and brainstem activity. This procedure improves PD symptoms and reduces levodopa-induced complications. However, its proximity to critical structures like the optic tract and internal capsule demands extreme precision. Microelectrode-guided electrophysiological mapping ensures accurate targeting while minimizing risks like hemiplegia or visual deficits. Effective perioperative care is pivotal for success.
Preoperative Care
- Psychological Support
PD patients, burdened by chronic disability, often harbor unrealistic expectations or fear complications. Nurses provide empathetic counseling, detailing the surgery’s purpose, process, and required cooperation. - Training for Intraoperative Cooperation
- Visual Stimulus Response: Patients learn to report flashes of light during electrode stimulation, aiding target localization. Preoperative training by nurses reduces intraoperative delays.
- Visual Field Monitoring: Patients practice identifying visual field changes to avoid postoperative deficits.
- Preparations
- Wear cotton clothing (avoids electrostatic interference).
- Withhold PD medications 12 hours pre-surgery to accentuate symptoms for intraoperative assessment.
- Train non-verbal patients to use gestures for communication.
Intraoperative Care
- Surgical Overview
Performed under local anesthesia, PVP combines MRI-guided anatomical targeting and microelectrode functional mapping (accuracy within 100μm). Radiofrequency ablation creates precise lesions. - Optimizing Patient Comfort
- Create a calming environment (music, conversation).
- Monitor and manage pain (e.g., massage for spasms).
- Vital Monitoring
Track blood pressure (maintain MAP <12kPa), pulse, respiration, and SpO₂ every 5 minutes. Address hypertension or bleeding promptly. - Post-Ablation Medication
Administer Madopar post-surgery to counteract dopamine depletion, preventing weakness. Ensure safe swallowing to avoid aspiration. - Encourage Mobility
Most patients walk out post-surgery, boosting confidence.
Postoperative Care
- General Care
- Elevate the head to reduce cerebral edema.
- Monitor vitals, manage fever, and explain recovery timelines.
- Psychological and Functional Rehabilitation
- Realistic Expectations: Emphasize symptom improvement (e.g., rigidity), not cure of structural issues (e.g., joint deformities).
- Exercise Advocacy: Counteract dependency on medication/surgery. Example: A patient regained self-care abilities through guided rehab.
Discharge Guidance
- Medication Adherence: Stress synergy between surgery and drugs.
- Diet: Avoid high-protein foods (e.g., dairy) to optimize drug absorption.
- Exercise: Promote daily physical therapy and functional training.
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