帕金森病丘脑腹中间核毁损术靶点的预定位及调整  

Preliminary localization and readjustment to the ventralis intermediate nucleus in stereotactic lesionfor Parkinson＇s disease

作　　者：刘将 魏祥品 傅先明 牛朝诗 李光群 汪业汉 

机构地区：[1]安徽医科大学附属省立医院神经外科,安徽省立体定向神经外科研究所,合肥23000l

出　　处：《中华神经外科杂志》2013年第12期1204-1207,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨帕金森病（PD）丘脑腹中间核（Vim）毁损术中靶点的定位方法。方法回顾性分析34例行Vim毁损的PD患者的临床资料及定位方法，即术中测量MRI定位片中第三脑室宽度、AC-PC线的长度，并据此对标准靶点的坐标做出相应调整，再通过术中电生理刺激对靶点位置进行二次调整。结果34例患者的平均连合间径长度及第三脑室宽度与立体定向图谱中的相应数值差异有统计学意义（P〈0．001）。其中9例根据MRI定位片对靶点进行预调整，电生理刺激有7例参数满意，2例行二次调整；余25例电刺激后有6例进行二次调整。术后所有患者震颤明显改善。结论根据MRI定位片中第三脑室宽度及连合间径长度结合标准脑立体定向解剖图谱对Vim进行预定位，再通过术中电生理刺激对靶点位置进行调整，可提高靶点定位的精确性及手术疗效。Objective To explore the method of targeting the ventralis intermediate nucleus in stereotactic lesion of PD. Methods Thirty - four PD patients had a operation with stereotactic lesion on the vim nucleus, which clinical datas were retrospectively reviewed. The width of the third ventricle and the length of the AC - PC line were measured of each patient during operation. According to the resuhs, standard coordinates of the target was adjusted accordingly when necessary and then was readjusted through electrophysiological stimulation. Results MRI - derived measurements of the average AC - PC distance and the average width of the third ventricle were compared to Schaltenbrand and Wahren Atlas, the differences were statistically significant（ P 〈 0. 001 ）. Standard coordinates of the target was adjusted in nine patients according to the MRI positioning pieces, 7 of them had satisfactory electrophysiological parameters during electrophysiological stimulation, and other 2 of them received readjustment of the target. There were 6 patients experienced readjustment of the target by electrophysiological stimulation in the rest of he 25 patients. The symptom of tremor was alleviated in all patients. Conclusion Preliminary localization to the vim nucleus according to the width of third ventricle and the length of AC - PC line from MRI positioning pieces combined with the standard stereotactic anatomical atlas and readjust the target rely on electronhvsioloeical stimulation can enhance the nreeiginn of Inca/inn an,＇] gur^ienl nlUenm,~

关 键 词：帕金森病 丘脑腹中间核 立体定向 射频毁损 

分 类 号：R742.5[医药卫生—神经病学与精神病学]