帕金森病外科治疗中苍白球内侧部神经元电生理记录的有效针道方法

目的探讨微电极记录技术在帕金森病(PD)苍白球切开术(Pallidotomy)治疗中的实际作用及应用方法。方法对120例PD苍白球内侧部神经元的电生理特征进行记录和分析，术中同时行电刺激检测，随后行射频毁损，术后2周～3月内行MR确认毁损灶位置．1年后病情随访。结果苍白球内侧部(Gpi)运动相关细胞分布具有规律性：下肢运动神经元位于Gpi的背侧．面及咀嚼肌相关运动神绎元位于Gpi最腹侧，上肢运动神经元位于其中，此结果为最终毁损治疗提供了患肢部位的信息：微电极记录在PD手术治疗中的作用主要是用于提供Gpi内神经元信息，即对所行针道异常电生理信号及视束光反应的确认，而非一定要多针道对Gpi或STN生理空间制图或边缘定位，由此提出“有效针道”的方法。结论对于GDi靶点位置的确定，除影象学定位外，微电极记录和电刺激同样重要；微电极记录技术的有效针道方法操作简单，易于临床上对神经核团定位，对GDi靶点定位十分重要。

The efficient needle-pathway method for physiological recording of the pallidal medial neuron in Parkinsonian surgical treatment

Objective To prove into the practical effect and the applicative method of microelectrode recording technique used in the treatment of Parkinson's disease (PD) with pallidotomy. Methods The physiological characteristics of the pallidal medial neuron of 120 cases of PD were recorded and analyzed, which were detected with electrical stimulus in the operation and then destructed with radiofrequency. The destructed foci were determined with MR three months after operation, with follow-ups performed according to the patient conditions after one year. Results The distribution of the action-related cells in Gpi proved regular: The motor neurons of the lower limb were located in the dorsal side of Gpi, those of the faces and mastication muscles in the ventral side of Gpi, and those of the upper limb in the middle of Gpi, which suggested the final treatment through destruction in the diseased limbs. In treating PD by operation, microelectrode was mainly used to offer the data about the neuron in Gpi, e.g. to determine abnormal electrical physiological signals and the reaction of optic tract light in the needle pathway instead of physiological space cartography and borderline location for Gpi and STN through poly-needle pathway. Thus the effective needle-pathway method was put forward. Conclusion As for the location of objective places of Gpi, both microelectrode recording and electric stimulus were of the same significance, besides iconographic location. Effective needle pathway in the microelectrode recording is of great importance for locating objective places of Gpi, because its operation is simple and easy for clinically locating the nerve nucleus masses.