脑深部刺激术靶点定位准确性的术中确认方法  

Method for intraoperative confirming target localization accuracy in deep brain stimulation

作　　者：梁晋川[1] 周晓平[1] 胡小吾[1] 姜秀峰[1] 郝斌[1] 王来兴[1] 曹依群[1] 金爱国[1] 

机构地区：[1]中国人民解放军第二军医大学附属长海医院神经外科,上海200433

出　　处：《中国微侵袭神经外科杂志》2009年第4期145-147,共3页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：国家自然科学基金项目(编号:30471776)

摘　　要：目的探讨脑深部电刺激术(DBS)术中确认靶点定位准确性的方法。方法回顾性分析146例帕金森病人行丘脑底核(STN)DBS治疗的靶点定位经验。单侧手术70例,双侧76例。术前采用磁共振扫描图像直接定位和坐标值定位相结合的方法计算靶点坐标,术中行微电极记录细胞外放电,通过观察微毁损效应、刺激效果和副作用,及X-线透视和戴立体定向仪行MRI复查进行靶点确认。结果术中电极植入后,112例肌张力增高病人中的76例、91例震颤病人中的44例和109例运动迟缓病人中的40例观察到微毁损效应。术中刺激时,106例仍有肌张力增高病人中的103例、86例震颤病人中的64例和109例运动迟缓病人中的69例有相应改善。在1.0～3.5V低电压刺激下,仅出现轻度异动副作用27例;而3.5～10.0V高电压刺激下出现各种明显副作用126例,其中3例因副作用阈值低而调整坐标。16例术中行C形臂X-线透视,发现电极过深4例;87例行术中MRI复查,发现电极过深16例,电极偏内3例。结论微毁损效应、刺激效果和副作用观察有助于判断电极位置的准确性;戴立体定向仪MRI复查能替代微电极记录,及时纠正电极位置偏差,减少脑出血和2次手术定位。Objective To explore the method for intraoperative confirming target localization accuracy in deep brain stimulation （DBS）. Methods Experience ofintraoperative target localization for DBS in 146 patients with Parkinson disease （PD） undergoing unilateral （n=70） or bilateral （n=76） subthalamic nucleus stimulation were analyzed retrospectively. Before the operation, the target coordinates were calculated by direct MRI neuroimaging and coordinates. During the operation, extracellular discharge Was recorded by a microelectrode, and the target localization accuracy was confirmed by observing the micro-ablative effect, stimulating effect, side effect, and by X-ray and MRI examinations. Results Micro-ablative effect was observed in 76 of 112 hypermyotonia, 44 of 91 tremor and 40 of 109 bradykinesia patients after electrode implantation. During stimulation, symptoms were relieved in 103 of 106 hypermyotonia, 64 of 86 tremor and 69 of 109 bradykinesia patients. 1.0 to 3.5V test stimulation caused mild side effects in 27 patients. Obvious side effects were observed in 126 patients receiving 3.5 to 10.0V test stimulation, among them 3 required changing the target coordinates because of low threshold of side effect. C-arm X-ray set was used in 16 patients, showing the electrodes were too deep-seated in 4. The electrodes were too deep-seated in 16 and too medial in 3 of 87 cases rechecked by MRI. Conclusion Accuracy of stereotactic electrode placement can be confirmed by observation of micro-ablative effects, test stimulation-induced effects and side-effects. Intraoperative MRI with stereotactic frame can replace the microelectrode recording and reduce hemorrhage and reoperation.

关 键 词：帕金森病 电极 植入 电刺激疗法 丘脑底核 

分 类 号：R742.5[医药卫生—神经病学与精神病学]