磁共振导向立体定向扣带回毁损靶点定位及毁损范围的研究

目的 探讨磁共振导向立体定向扣带回毁损的最佳靶点及毁损灶范围. 方法 回顾性分析71例行磁共振导向立体定向扣带回毁损患者的资料,其中慢性疼痛7例.精神疾病64例;扣带回靶点选择为:X:5mm,Y:侧脑室尖后10～20mm,Z:侧脑室上2 mm,并根据磁共振三维定位影像确定及调整靶点及毁损范围;用温控射频仪制作毁损灶,电极直径1.6mm,尖端裸露4mm,毁损温度75℃,时间100 S,毁损灶大小15 mm×10 mm×10 mm.全部患者分别于术后3 d及2月行影像复查.结果 所有患者术后影像复查显示毁损灶完全位于扣带回前部;2例发生短暂性尿失禁,无永久性并发症发生;7例慢性疼痛术后疼痛缓解满意,64例精神疾病手术后结果为优3例,显著进步35例,进步22例,无效4例. 结论 利用磁共振导向行立体定向扣带回毁损手术可以清晰的辨认出扣带回形态及周围结构,最佳的靶点毁损范围为胼胝体顶向后10～25 mm,扣带回底向上高10 mm,宽10 mm.

Best target position and range of lesion for magnetic resonance image -guided stereotactic cingulotomy

Objective To explore the best target position and range of lesion for magnetic resonance image (MRI)-guided stereotactic cingulotomy. Methods We retrospectively analyzed the data of 71 patients underwent MRI-guided stereotactic cingulotomy, including 7 with chronic pain and 64 with psychiatric disorders. The cingulate gyrus target chose were 5 mm as X, 10-20 mm posterior tip of the lateral ventricle as Y, 2 mm above the roof of the lateral ventricle as Z. The target position and range of lesion were determined and revised by routine sagittal, axial and coronal stereotactic MRI scans. Radiofrequency thermocoagulation lesions were produced by inserting an electrode (1.6 mm diameter and 4 mm uninsulated tip) and heating them at a temperature of 75℃ for 100 seconds with a volume of lesion reaching 15 mm×10 mm×10 mm. Early postoperative MR or CT scans and long-term followed up examination were available for all cases. Results Postoperative images showed that the lesions were all in the anterior cingulate gyrus. Two patients reported transient urinary incontinence without permanent complications; significant pain relief appeared in all patients with chronic pain; In 64 with intractable psychiatric disorders, cure was showed in 3 obvious improvements in 35, improvement in 22, and no change in 4. Conclusion MRI-guided stereotactic cingulotomy offers substantial advantages by allowing direct visualization of the cingulate gyrus and surrounding structures and the best range of lesion is 10-25 mm from the anterior point of the corpus callosum, 10 mm above the bottle of cingulate gyrus and 10 mm in width.