脑深部刺激术中丘脑底核靶点定位方法探讨

目的 分析脑深部刺激术(DBS)中丘脑底核(STN)靶点的定位方法。方法 对30例帕金森病(PD)患者进行STN DBS治疗，其中单侧19例，双侧11例。MRI扫描后，采用图像和坐标相结合的方法计算STN靶点坐标，微电极记录细胞放电，植入电极刺激，观察刺激效果和不良反应。结果 MRI能显示STN，微电极记录能明确STN边界，术中植入电极刺激能观察患者的刺激效果和不良反应。结论 MRI图像直接定位STN较准确，微电极记录和植入电极刺激能对靶点定位作进一步验证和适当调整。     

微电极导向苍白球腹后部毁损术治疗帕金森病

目的 探讨苍白球后部毁损术（PVP0治疗帕金森病（PD）的手术方法及疗效。方法 采用坐标定位结合MRI图象定位,在微电极导向下,完成对6例病人单侧苍白球腹后部（Gpi)的定位,并实施毁损。结果 6例病人的震颤、僵硬及运动迟缓均得到明显改善,UPDRS运动部分积分“开”状态下改善率32．2％,“关”状态下改善率58．6％,无永久并发症。结果 坐标结合MRI图像法能确定位Gpi,微电极记录是其必要的补充。PVP能全面改善PD病人的征象,是一种安全有效的方法。     

微电极记录在定向苍白球鼠损治疗帕金林病手术中的应用

目的：提高苍白球毁损术的定位精度。方法；通过微电极细胞电生理记录技术对７０例７１次苍白球毁损术进行苍白球内细胞电生理记录，分析电信号，确定手术靶点。结果：经微电极细胞电生理记录及分析，最终手术靶点较ＣＴ靶点更换率为８２．８％，手术效果显著，并发症少。结论：通过微电极细胞电生理记录技术对苍白球毁损术进行术中定位监测，能够克服个体脑内靶点在解剖上和功能上的变异，提高了定位的精确度和治疗效果。     

微电极记录技术在立体定向手术治疗帕金森病中的应用

目的：提高立体定向手术的定位精确度。方法：32例帕金森患者均采用CT定位。通过微电极描述和记录苍白球腹后内侧部（Gpi)及丘脑腹外侧核（Vim)的电生理信号。从而pi和Vim核的电生理靶点。结果：电生理靶点坐标与原始CT靶点坐标的更换率为64%。总有效率为90%,无永久性并发症,结论：微电极记录技术的应用提高了手术治疗帕金森病的效果。降低了手术并发症。     

微电极导向苍白球腹后部切开术治疗帕金森病13例临床研究

目的：探讨苍白球腹后部切开术（PVP）治疗帕金森病（PD）的手术方法和临床效果。方法：采用坐标定位结合计算机计系统和MRI图像定位,应用微电极导向技术对13例原发性PD病患者实施了立体定向苍白球切开术。采用UPDRS评分量表对所有患者进行术前和术后的病情评分。结果：13例患者的震颤、僵硬及运动迟缓均得到明显改善,无其他特殊并发症发生。结论：苍白球切开术是治疗PD病患者的一种安全、有效的治疗方案,微电极记录是必要的。     

微电极记录在定向苍白球毁损治疗帕金森病手术中的应用

目的:提高苍白球毁损术的定位精度.方法:通过微电极细胞电生理记录技术对70例71次苍白球毁损术进行苍白球内细胞电生理记录,分析电信号,确定手术靶点.结果:经微电极细胞电生理记录及分析.最终手术靶点较CT靶点更换率为82.8%,手术效果显著,并发症少.结论:通过微电极细胞电生理记录技术对苍白球毁损术进行术中定位监测,能够克服个体脑内靶点在解剖上和功能上的变异,提高了定位的精确度和治疗效果.     

微电极导向苍白球腹后部毁损术治疗帕金森病

目的探讨苍白球腹后部毁损术(PVP)治疗帕金森病(PD)的手术方法及疗效。方法采用坐标定位结合MRI图象定位,在微电极导向下,完成对6例病人单侧苍白球腹后部(Gpi)的定位,并实施毁损。结果6例病人的震颤、僵硬及运动迟缓均得到明显改善,UPDRS运动部分积分“开”状态下改善率32．2％,“关”状态下改善率58．6％,无永久并发症。结论坐标结合MRI图象法能准确定位Gpi,微电极记录是其必要的补充。PVP能全面改善PD病人的征象,是一种安全有效的方法。     

微电极靶点定位外科治疗帕金森病

目的：探讨微电极记录技术在帕金森病外科治疗中的作用。方法：采用微电极电生理记录技术监测术中靶点,对帕金森病３１例进行手术治疗,其中苍白球毁损术１４例、丘脑毁损术６例、深部脑电刺激术１１例。结果：最终毁损靶点较ＭＲ定位靶点位置更换率为８０．６％,手术效果优良,有效率１００％,原发有太术后改善率达８７．１％,无永久并发症。结论：微电极记录技术的应用能显著提高定位精度,减少并发症和提高手术效果。     

微电极记录技术手术治疗帕金森病的CT影像学评价

目的　评价帕金森病 (PD)在微电极导向下行丘脑腹外侧核 (Vim核 )和苍白球腹后部 (PVP核 )毁损术的CT影像学定位作用及术后 CT表现。方法　术前对 1 80例 PD患者行 CT定位 ,并与术中微电极记录电生理定位靶点对比分析。术后 2 4小时内 CT复查。 1 0例 6～ 8月内 CT复查。结果　 1 CT定位靶点吻合率为 34% ,更正率为 66% ,更正范围为 2± 1 .5mm。 2术后靶点毁损灶及周围水肿 CT表现为边缘模糊的低密度区 ,其范围波及内囊区 (1 0 0 % )或 /和视束 (2 5% ) ,平均大小分别为 :单靶点毁损为 486± 1 0 8mm3 ,双靶点毁损为 977± 2 34mm3。1 0例术后 6～ 8个月 CT复查 ,毁损灶大小为 2 9.5± 1 9.8mm3 。 3术后并发症 :毁损灶出血 1 0例 ,针道出血 4例。结论　影像学定位是手术成功及减少并发症的关键。术后 CT表现对了解和评价术后情况及指导临床治疗具有重要意义。     

帕金森病脑立体定向术磁共振靶点定位研究

目的　探讨帕金森病脑立体定向术磁共振靶点定位最佳方式。方法　对 68例帕金森病患者行磁共振结合微电极记录定位 ,立体定向脑核团 (Vim或 Gpi)毁损术。随机分为两组 ,靶点分别采用中反转恢复序列 (IR)扫描直视定位和常规自旋回波 (SE)序列扫描解剖间接定位。以术中微电极记录和射频刺激验证确定的毁损靶点为标准 ,观察毁损靶点与影像定位靶点坐标的一致性 ,统计两种 MRI定位方式下预定靶点与毁损靶点坐标符合率 ,结合疗效分析评价两种定位法。结果　 32例行 IR扫描直视定位 ,36例行 SE扫描间接定位。术中靶点符合率前者均为 87.5% (Vim和 Gpi) ;后者为 33.33% (Vim)和 37.93% (Gpi)。两种定位法靶点符合率存在显著差异 (P<0 .0 5)。MRI直视定位较解剖间接定位电生理靶点符合率高。结论　 IR序列是 MRI帕金森病立体定向靶点定位的优选扫描方式。其个体化直视定位靶点对提高疗效、减少手术损伤、避免并发症发生有重要意义     

Off-line analysis of single-unit neuronal discharge in the globus pallidus region in Parkinson’s disease

Background The accuracy of microelectrode-guided localization can make the operation safe and effective, but only experienced neurosurgeons are capable of performing this operation. A good index to identify neuronal discharges between globus pallidus interna and globus pallidus externa is needed. The aim of this research was to establish a good and practical electrophysiologic index to distinguish neuronal discharge in the interior globus pallidus from neuronal discharge in the exterior globus pallidus region of the brain in Parkinson＇s disease. The effect of neurons having an atypical discharge on successful surgical localization was also quantitatively evaluated Methods The study included 30 patients with primary Parkinson＇s disease who underwent pallidotomy between September 2000 and October 2002. During each pallidotomy, the neuronal discharges in the pallidum and its vicinity were recorded. The recorded spikes were used to calculate the frequency, burst index, pause index, and pause ratio of the single-unit discharge. The interior and exterior globus pallidus regions were compared in terms of frequency, burst index, pause index, and pause ratio. The sensitivity, specificity, false-negative ratio, false-positive ratio, and accuracy of those indices were then evaluated. Results The values of frequency, burst index, pause index, and pause ratio in the interior globus pallidus were （96±43） Hz, 2.31±1.81, 0.05±0.05, and 0.27±0.28, respectively, and in the exterior globus pallidus were （59±27） Hz, 0.88±0.63, 0.20±0.14, and 1.54±1.17, respectively. Use of the four indices to distinguish the two neuron types produced a sensitivity of 0.84, 0.78, 0.77, and 0.93 with a specificity of 0.64, 0.79, 0.88, and 0.87, respectively. The false-positive ratio was 0.36, 0.21, 0.12, and 0.13 and the false-negative ratio was 0.16, 0.22, 0.23, and 0.07 while the accuracy was 0.72, 0.79, 0.80, and 0.90, respectively. Conclusions Pause ratio is a relatively reliable index to distinguish neuronal discharges between the interior and exterior globus pallidus regions in Parkinson＇s disease. The effect of neurons with atypical discharge on the successful surgical localization would be reduced to 10% when the pause ratio is used as the index.     

微电极靶点定位外科治疗帕金森病

目的探讨微电极记录技术在帕金森病外科治疗中的作用。方法采用微电极电生理记录技术监测术中靶点，对帕金森病31例进行手术治疗，其中苍白球毁损术14例、丘脑毁损术6例、深部脑电刺激术11例。结果最终毁损靶点较MR定位靶点位置更换率为80．6％，手术效果优良，有效率100％，原有症状术后改善率达87．1％，无永久并发症。结论微电极记录技术的应用能显著提高定位精度，减少并发症和提高手术效果。     

Deep brain stimulation in the treatment of secondary dystonia

Background Dystonia is one of the most challenging movement disorders to treat. Medications and surgeries are the two methods to control dystonic symptoms. For patients with dystonia in whom symptoms are inadequately controlled with pharmacologic measures, the use of deep brain stimulation （DBS） can improve symptoms and enhance functional capacity. The best candidate for DBS is believed to be primary generalized dystonia, especially the DYT-1 type. Here, we report 9 cases of secondary dystonia to explore the feasibility, indications and complications of DBS in the treatment of secondary dystonia. Methods From July 2003 to June 2006, nine patients with secondary dystonia underwent surgery at Beijing Tiantan Hospital. Among them, 2 were diagnosed as having tardive dystonia, 1 had posttraumatic dystonia, 3 had a history of perinatal anoxia, 1 had neonatal pathologic jaundice, and 2 had no exact contributory history; MRI showed bilateral lentiform nuclei degeneration in one patient. Six patients underwent bilateral subthalamic nucleus （STN）-DBS, two underwent unilateral STN-DBS, the other underwent left STN and fight globus pallidus internus（GPi）-DBS. Results With intraoperative microelectrode recording, the targeted nucleus was accurately localized. Tentative stimulation could decrease muscle tension to the same extent, but twisting was not obviously improved. Follow-up for 3 months to 3 years showed satisfactory results in 3 patients with tardive dystonia and posttraumatic dystonia and that Burke-Fahn-Marsden Dystonia Scale （BFMS） decreased by more than 90%. The improvement of symptoms was progressive along with time. The other 6 patients had slight to moderate improvement. None of them had severe surgery-related complications. One had lead fracture 16 months after surgery and the lead was then evacuated. Conclusions DBS could be an ideal treatment for patients with tardive and posttraumatic dystonia. For patients with perinatal anoxia and diffuse impairment in the basal ganglia, DBS seemed not to be a good choice. STN could be an ideal target. Intraoperative microelectrode recording and mild amelioration of muscle tension are indicators of correct target location. No severe complications occurred.     

微电极记录技术在帕金森病手术中的应用

目的 微电极记录技术提高帕金森病手术的靶点定位精度。方法 在苍白球毁损术（１４例）、丘脑毁损术（８例）病人中，采用微电极电生理记录技术进行术中靶点监测。结果 最终毁损靶点较ＭＲ更换率为８１．８％，手术效果优良，有效率１００％，无永久并发症。结论 应用微电极技术能显著提高靶点定位精度，减少并发症和提高手术效果。     

Comparative study of the sectional slice of the anterior commissure and the internal capsule with its MRI images

Objective:The brain of 100 normal persons were performed MRI scan and image analysis.12adult female brain specimens fixed by formalin,were made into the thickness of 0.5mm by celloidin embedding technique.We analyzed the anatomical position of the relationship about the anterior limb of internal capsule and the anterior commissure in eollodion-embedded plans,and then compared with the brain MRI of normal people.We also further compared the statistical differences of the internal capsule’s volume.This research aimed to provide a reliable sectional anatomic basis for the study of the central nervous system and deep brain stimulation to treat the mental neurological diseases.Results:1.Continous observation of celloid in brain slices horizontal section:Approximately 130 slices of each specimen,from the parietal lobe,the internal capsule was the typical structure"><"on the level of about 35 mm.On the level of about 41mm,the anterior commissure was"arc"through the bottom head of the caudate nucleus connecting the bilateral anterior limb,which located between the caudate nucleus and the lentiform nucleus.The posterior limb of internal capsule situated between the dorsal thalamus and the lentiform nucleus on the level of about 46 mm.Coronal section:about 150 slices of per specimen,from the former lateral ventricle horn back,on the level of about 16 mm the anterior commissure was"arch"connecting the anterior limb.About 28 mm dimension,the interior capsule fore limb located between the caudate nucleus and the putamen,the posterior limb of internal capsule located between the globus pallidus and the dorsal thalamus,extending down to the cerebral peduncle.Sagittal section:about 180 slices of per specimen,from the outside to the inside at the beginning of the temporal lobe,the corona radia taextends between the putamen and dorsal thalamus,and then formsthe posterior limb of the internal capsule at the level of about 21 mm.About 25 mm level,fore limb located between the caudate nucleus and the putamen;Genu of the internal capsule located between the caudate nucleus and dorsal thalamus;the posterior limb of internal capsule located between the putamen and the dorsal thalamus,and then extends to the brain stem.2.The observation of brain MRI images horizontal position:Above the typical level of the internal capsule,internal capsule showed high signal,and the boundaries could be still recognized.Below the typical levels of the internal capsule,the globus pallidus and the anterior limb of the internal capsule showed low signal intensity,and both ill-defined,but we could still identify the boundaries of the internal capsule fore limbs.Coronal position:Before the globus pallidus appeared,the tomography of collodion brain slices and brain MRI images were basically the same form.MRI images could be observed clearly that the anterior commissure connected the bilateral the anterior limbs.Sagittal position:The corona radiata was not observed in the MRI images,and thento switch toward the internal capsule.The emergence of dorsal thalamus and globus pallidus boundaries were not observed clearly.3.Three dimensional reconstruction and analysis of the measurement results The anatomical structural features of the internal capsule and adjacent structures could be continuously,multi-directionally and then dynamically observedon the horizontal,coronal and sagittal plane by three dimensional reconstruction.The anatomical localization of the posterior limb of the internal capsule can be clearly observed in the sagittal plane.The volume data of the left and right internal capsule was statistically significant.Conclusions:1.The experiment described anatomical localization and the three-dimensional model of the internal capsule and anterior commissure in detail,and to provide a reliable basis for the functional anatomy relations between the two follow-up studies.2.Comparing continuous thin brain slices with the corresponding section of the brain MRI images study,the brain slices collodion show much more clearly than the MRI image about the positional relationship between the internalcapsule and adjacent structures.3.Measurements of the internal capsule and its various divisions on the left and right were statistically significant to provide data support for the asymmetry of brain morphology study.     

新生儿胆红素脑病MRI表现

目的:探讨新生儿胆红素脑病MRI表现及鉴别诊断,提高对本病的认识。方法:回顾分析19例新生儿胆红素脑病的影像及临床资料。结果:19例患儿中16例头颅MRI苍白球T1WI呈对称性高信号,T2WI呈等信号,扩散加权成像(dif-fusion weighted imaging,DWI)序列均未见信号改变。3例血清总胆红素(serum total bilirubin,TSB)值大于700 mol/L的患儿,双侧苍白球和腹侧丘脑T1WI均呈对称性稍高信号,其中2例急性期DWI序列未见异常,1个月后复查DWI呈高信号,苍白球T2WI出现高信号。1例未复查。结论:MRI-T1WI苍白球对称性高信号具有一定的特征性,DWI成像对本病的鉴别诊断有一定帮助。