Rampini P, Egidi M, Zavanone M, Orsi M, Farabola M, Sina C
Institute of Neurosurgery, Polyclinics IRCCS, University of Milan, Italy.
J Neurosurg Sci. 1998 Dec;42(4):195-201.
Ventriculography is still considered an unavoidable step for functional target localization, even though this method is invasive and requires stereotactic rooms, orthogonal frames, and parallax-free X-ray equipment. In this experimental study, the authors investigated the feasibility of performing stereotactic lesions using a conventional, widely employed frame, such as the Brown-Roberts-Wells (BRW) apparatus, and computerized axial tomography (CAT) imaging.
Five ex vivo models consisting of cadaveric brains enclose in a plastic shell were fixed in a BRW frame. A simple BRW implementation was used to ensure more symmetrical placement of the basal ring. Two-millimeter plastic balls were inserted at the level of the anterior (AC) and posterior commissures (PC) and at the target in the pallidus. Their final position was measured on the anatomical specimens and compared with Schaltenbrand Atlas maps.
The error in estimating the length of the intercommissural line ranged from 0.5 mm to 2.0 mm, with a maximum backward angulation of four degrees in predicting the AC-PC plane. Upon dissection, in four out of five cases, the balls were found within the area of the pallidus defined by Laitinen for posteroventral pallidotomy.
The authors conclude that anatomical identification of the AC-PC line and the pallidus target, using the BRW stereotactic system and CAT axial images alone offers sufficient accuracy. They suggest that functional neurosurgery for movement disorders could be safely and successfully carried out without ventriculography if neurophysiological monitoring is also employed.
脑室造影术仍被认为是功能靶点定位中不可避免的一步，尽管这种方法具有侵入性，且需要立体定向室、正交框架和无视差X射线设备。在本实验研究中，作者探讨了使用传统的、广泛应用的框架（如布朗 - 罗伯茨 - 韦尔斯（BRW）装置）和计算机断层扫描（CAT）成像进行立体定向损伤的可行性。
五个由包裹在塑料壳中的尸体脑组成的离体模型被固定在BRW框架中。采用简单的BRW操作来确保基底环放置得更加对称。在前后连合（AC）和苍白球靶点水平插入2毫米的塑料球。在解剖标本上测量它们的最终位置，并与沙尔滕布兰德图谱进行比较。
估计连合间线长度的误差范围为0.5毫米至2.0毫米，预测AC - PC平面时最大向后成角为4度。解剖后，在五例中有四例发现球位于莱蒂宁定义的苍白球腹后切开术的苍白球区域内。
作者得出结论，仅使用BRW立体定向系统和CAT轴向图像对AC - PC线和苍白球靶点进行解剖学识别就具有足够的准确性。他们建议，如果也采用神经生理学监测，运动障碍的功能神经外科手术可以在不进行脑室造影的情况下安全、成功地进行。
