帕金森病患者年龄及侧脑室体积与STN—DBS针道角度的相关性研究  

Recommended electrode angle of subthalamic nucleus deep brain simulation for Parkinson＇s disease patients and its correlation with lateral ventricle volume and age

作　　者：张伟忠[1] 卢凤飞[1] 薛杉[1] 汪浩源[1] 姚晨[1] 何骁征[1] 张世忠[1] 

机构地区：[1]国家临床重点专科教育部工程技术研究中心,广东省脑功能修复与再生重点实验室南方医科大学珠江医院神经外科,广州510282

出　　处：《中华神经医学杂志》2016年第6期585-591,共7页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金（81501046、81371397、81172416）国家临床重点建设专科资助项目广东省神经外科临床中心资助项目

摘　　要：目的通过比较不同年龄、侧别、侧脑室体积PD患者丘脑底核（STN）．脑深部电刺激（DBS）手术针道角度差异构建出相应的针道角度参考表，以提供安全的进针角度。方法收集珠江医院神经外科自2009年1月至2015年12月年收治的40例PD患者术前MRI数据，利用mimics软件进行侧脑室、STN三维重建，测量Evans指数，重建侧脑室体积，并取不同Ring角度（50～60°，共11组），截取相应侧脑室和STN平面，测量该截面对应的slide角度。比较年龄与侧脑室体积的相关性，并按年龄分为A组（60～69岁）、B组（40～59岁），比较其进针角度的差异；同时比较左右侧进针角度差异，并按Evans指数分组，比较其针道角度差异。最后结合临床，总结出针道角度参考表。结果年龄与总侧脑室体积、左侧脑室体积、右侧脑室体积之间的Pearson相关系数分别为0．364、0．384、0．362，差异具有统计学意义（P〈0．05）；A、B2组不同Ring角测得的进针角度差异均没有统计学意义（P〉0．05）；左右侧进针角度差异具有统计学意义（P〈0．05）。侧脑室体积及Evans指数与针道角度均呈正相关，而且不同Evans分组之间针道角度差异有统计学意义（P〈0．05）；根据不同侧别不同Evans分组，计算针道角度的95％置信区间，并取其上限，得到最终的针道角度参考表。结论PD患者侧脑室随年龄增大而增大，不同侧别、侧脑室体积与针道角度有关；本研究提供的针道角度参考表能为临床手术提供一定帮助。Objective The inadvertent lateral ventricle puncture is still a problem in subthalamic nucleus deep brain stimulation （STN-DBS） surgery, to which a solution is found in this study with a better choice of electrode angle in STN-DBS by reconstruction of the lateral ventricle and STN. Methods Forty patients with Parkinson＇s disease, admitted to our hospital from January 2009 to December 2015, were chosen in our study. According to the MRI data of the patients, the lateral ventricle and STN were reconstructed with mimics software; Evans indexes were measured, and the volume of lateral ventricle was reconstructed. Different lateral ventricle and STN planes were captured by using different Ring angles （50-60°, n=11）, and the Slide angles of these planes were measured. The patients were divided into two groups according to their age： Group A （60-79-year-old） and Group B （40-59-year-old）; their volume of lateral ventricle was measured and compared between the two groups; the correlation between age and volume of lateral ventricle was analyzed; the difference of electrode angle was compared between the two groups and the right and left side of the same group; according to the Evans indexes, these patients were then divided into three groups, the Slide angle and Ring angles were measured and the different angles between left and right brain and among the Evans groups were analyzed so as to give a recommended angle in the STN-DBS. Results Age was positively related to the volume of lateral ventricle, and left one and right volume of lateral ventricle （Pearson correlation index： 0.364, 0.384 and 0.362）, which had statistical significance （P〈0.05）. No significant difference on electrode angle was noted between group A and B of different Ring angles （P〉0.05）, while significant difference was noted on right and left electrode angle between the two groups （P〈0.05）. Positive correlations were noted between volume of lateral ventricle and both Evans indexes and electrode angle, and diff

关 键 词：帕金森病 脑深部电刺激 丘脑底核 侧脑室 三维重建 针道角度 

分 类 号：R742.5[医药卫生—神经病学与精神病学]