Guridi J, Gorospe A, Ramos E, Linazasoro G, Rodriguez M C, Obeso J A
Centro de Neurologia y Neurocirugia Funcional, Clinica Quiron, San Sebastian, Spain.
Neurosurgery. 1999 Aug;45(2):278-87; discussion 287-9. doi: 10.1097/00006123-199908000-00017.
The reintroduction of pallidotomy for the treatment of Parkinson's disease (PD) has generated various opinions regarding the ideal anatomic or physiological location of the target within the globus pallidus. The role of microelectrode recording guidance in pallidotomy for the treatment of advanced PD is presently under debate. The purpose of this study was twofold. The first goal was to determine the degree of accuracy in the targeting of the globus pallidus internus (GPi) with magnetic resonance imaging (MRI), by comparing these results with the final placement of the thermolytic lesions (as defined by electrophysiological assessment). The second goal was to ascertain the somatotopic arrangement of the GPi in PD.
The analysis involved 50 patients with PD who underwent microrecording-guided pallidotomy. The theoretical coordinates for lesioning were calculated after definition of the intercommissural line by MRI. The actual placement of the lesions was determined after mapping of the GPi by microrecording, using stimulation to identify the sensorimotor region and its somatotopic organization.
In most cases, the lesions were placed posterior and lateral to the targets chosen by MRI. Mapping by microrecording revealed differences of 2.3 +/- 1.55 mm and 3 +/- 1.9 mm in the mediolateral and anteroposterior coordinates, respectively. The actual lesion overlapped the theoretical target for only 45% of the patients. The somatotopic organization of the GPi was analyzed. Most of the units with sensorimotor activity or tremor-related activity were in the lateral portion of the nucleus. Upper limb and axial units were in the most lateral region and mainly in the ventral one-third of the nucleus. Lower limb responses were recorded mainly in the dorsal one-third of the nucleus. Tremor-related cells were found throughout the sensorimotor region of the nucleus.
These results indicate that lesion targeting based on MRI alone is not sufficiently accurate to guarantee placement of the lesion in the sensorimotor region of the GPi.
苍白球切开术重新用于治疗帕金森病（PD）引发了关于苍白球内理想解剖或生理靶点位置的各种观点。目前，微电极记录引导在晚期PD苍白球切开术中的作用存在争议。本研究有两个目的。第一个目标是通过将磁共振成像（MRI）结果与热凝毁损灶的最终位置（由电生理评估确定）进行比较，来确定利用MRI靶向内侧苍白球（GPi）的准确程度。第二个目标是确定PD中GPi的躯体定位排列。
分析纳入了50例行微记录引导苍白球切开术的PD患者。通过MRI确定连合间线后计算毁损的理论坐标。在通过微记录对GPi进行定位后，利用刺激来识别感觉运动区域及其躯体定位组织，从而确定毁损灶的实际位置。
在大多数情况下，毁损灶位于MRI所选靶点的后方和外侧。微记录定位显示，在内外侧和前后坐标上分别存在2.3±1.55毫米和3±1.9毫米的差异。实际毁损灶仅在45%的患者中与理论靶点重叠。对GPi的躯体定位组织进行了分析。大多数具有感觉运动活动或震颤相关活动的神经元位于核团的外侧部分。上肢和轴性运动神经元位于最外侧区域，主要在核团腹侧三分之一处。下肢反应主要记录在核团背侧三分之一处。在核团的整个感觉运动区域均发现了震颤相关细胞。
这些结果表明，仅基于MRI的毁损灶靶向定位不够准确，无法确保将毁损灶置于GPi的感觉运动区域。
