苍白球内侧部毁损术中靶点的综合定位法  

Combined target localization for Gpi pallidotomy

作　　者：凌士营[1] 傅先明[1] 凌至培[1] 汪业汉[1] 

机构地区：[1]安徽省立医院神经外科,安徽合肥230001

出　　处：《中华神经外科疾病研究杂志》2004年第4期304-308,共5页Chinese Journal of Neurosurgical Disease Research

基　　金：安徽省自然科学资金资助项目 (990 4 4 61 6)

摘　　要：目的　介绍综合定位法在苍白球内侧部 (Gpi)毁损术中的应用。方法　对 5 9例Gpi毁损术中的靶点综合性定位方法进行回顾性总结。先根据Shaltenbrand图谱和姚家庆图谱 ,确定一个标准的Gpi坐标 ,X =18mm ,Y =2mm ,Z = 6mm ,再通过MRI定位扫描、粗电极刺激和微电极记录三种方法对标准靶点坐标进行三次修改。最后 ,在对靶点进行试验性毁损后 ,制作永久性Gpi毁损灶。结果　第一次标准靶点修改例数为 5 0例 ,修改范围 :x=0～ 4mm ,y=1～ 2mm ,z=0～ 3mm ;第二次修改例数为 18例 ,修改范围 :x=1～ 3mm ,y=1～ 1.5mm ,z=1～ 1.5mm ;第三次修改例数为 9例 ,修改范围 :x=0 .5～ 1mm ,y=0 .5mm ,z=0 .5～ 1.5mm ,而且大多数仅在z轴上进行修改。所有病例均获得良好手术效果。结论　最大限度地利用MRI定位扫描和粗电极刺激所获得的信息 ,是Gpi毁损术中靶点定位的基本方法 。Objective This study discussed a strategy for stereotactic targeting of global pallidus internus (Gpi), which maximized the anatomical and physiological information obtained from the high solution MRI, macroelectrode stimulation and microelectrode recording, and led to one electrode track necessary to get optimal target localization for Gpi, and a minimal likelihood of complications due to multiple penetrations of brain tissue.Methods 59 patients undergoing Gpi pallidotomy were prospectively analyzed. The standard target coordinates(X=18, Y=2, Z=-6) were selected for all Gpi pallidotomies. The Leksell series G frame was placed with its Y axis parallel to the AC-PC line. Axial and coronal MR images were obtained orthogonal to the frame axis. With high solution MRI, the internal capsule and the boundaries of Gpi could be visualized directly. So the standard target coordinates may be modified for the first time. With macroelectrode stimulation, the standard target coordinates were modified for the second time. The single microelectrode track was placed on a parasagittal plane to find the ventral border of Gpi. The standard target coordinates were modified for the third time.Results By using high solution MRI, the modification of standard target coordinates ranged from 0 to 4 mm in X axis and from 0 to 3 mm in Z axis, in Y axis only 1 to 2 mm. After macroelectrode stimulation 18 patients' coordinates required to be modified. According to microelectrode recording, only 9 should be modified. All patients got good results. Conclusion Macroelectrode stimulation coupled with high solution MRI becomes the foundations for achieving effective Gpi pallidotomy. Microelectrode recording shows the hyperactive neuronal firing patterns in the internal pallidum and in the lower boundary of the pallidum.

关 键 词：苍白球内侧部毁损术 靶点 综合定位法 MRI定位扫描 粗电极刺激 微电极记录技术 帕金森病 

分 类 号：R742.5[医药卫生—神经病学与精神病学]