苍白球腹后内侧部毁损治疗帕金森病靶点定位研究

目的　探讨MRI定位微电极引导的苍白球腹后内侧部毁损术治疗帕金森病靶点定位方法及其规律。方法　 39例原发PD病人施行PVP术 ,UPDRS评分改善率大于 35 %。采用MRI进行靶点解剖定位 ,同时在MRI操作台上测量有关参数。术中用电生理方法对靶点做必要的调整。结果　MRI具有较高的分辨率 ,对靶点定位具有直接、准确等优点 ,Gpi靶点坐标在不同的个体有很大差异 ;靶点坐标X与三脑室宽度 (W )和AC -PC线长度 (L)之间存在线性依从关系 ,即 :^X =10 .0 9 0 .30L 0 .4 8W。 结论　PVP术治疗帕金森病效果满意 :通过MRI扫描 ,实现了Gpi靶点解剖定位个体化 ,提高了定位精度 ;应用电生理学方法调整靶点是必要的 ,并实现了靶点的功能定位 ;靶点X坐标值与三脑室宽度和AC -PC线长度有相关性

Localizating method and regular pattern of posteroventral pallidotomy

Objective To study localizating method of posteroventral pallidotomy in order to cure Parkinson's disease and study the regular pattern of the target coordinates.Methods Thirty nine consecutive cases using the pallidal target were studicd.The patients who underwent PVP for parkinson's disease had excellent results.The change rate of the whole scale of UPDRS are more than 35%.Targeting was aided by anatomic coordinates derived from the MRI,intraoperative cell recording and electrical stimulation prior to lesioning .The length of AC PC line or skull and the width of third ventricle or skull were measured in workstation of magnetic resonance imaging(MRI).Results MRI can provide exquisite neuroanatomic detail and could theoretically be used directly to target desired structure.The Gpi target coordinates show significant variability.Microelectrode recording (MER) and macroelectrode stimulation provide important target information for performing pallidotomy.They led to targeting changes from 1 to 3 mm in 48.7% Relationship between target coordination(X) and the third ventricle width(W) or AC PC length(L) was analysed:=10.09 0.30L 0.48W,R 2=0.7258. Conclusion Magnetic resonance imaging based initial stereotactic targeting of the Gpi,based on direct visulization of the target boundaries,is useful to improve target accuracy over that of purely indirect anterior and posterior commissure based targeting methed;The electrophysiological methods play a very important role in the posteroventral pallidotomy.The lateral position of the desired target in the Gpi highly coorelated positively with the third ventricle width and AC PC length,nor is the verticle position.Neither the skull length nor the skull width coorelated with the target coordinates.