肌张力障碍儿童深部脑刺激术中磁共振成像立体定向靶点定位

Magnetic resonance imaging stereotactic target localization for deep brain stimulation in dystonic children.

作者信息

Vayssiere N, Hemm S, Zanca M, Picot M C, Bonafe A, Cif L, Frerebeau P, Coubes P

机构信息

Department of Pediatric Neurosurgery, University Hospital, Montpellier, France.

出版信息

J Neurosurg. 2000 Nov;93(5):784-90. doi: 10.3171/jns.2000.93.5.0784.

DOI:10.3171/jns.2000.93.5.0784

PMID:11059658

Abstract

OBJECT

The actual distortion present in a given series of magnetic resonance (MR) images is difficult to establish. The purpose of this study was to validate an MR imaging-based methodology for stereotactic targeting of the internal globus pallidus during electrode implantation in children in whom general anesthesia had been induced.

METHODS

Twelve children (mean follow up 1 year) suffering from generalized dystonia were treated with deep brain stimulation by using a head frame and MR imaging. To analyze the influence of distortions at every step of the procedure, the geometrical characteristics of the frame were first controlled using the localizer as a phantom. Then pre- and postoperative coordinates of fixed anatomical landmarks and electrode positions, both determined with the head frame in place, were statistically compared. No significant difference was observed between theoretical and measured dimensions of the localizer (Student's t-test, ¿t¿ > 2.2 for 12 patients) in the x, y, and z directions. No significant differences were observed (Wilcoxon paired-sample test) between the following: 1) pre- and postoperative coordinates of the anterior commissure (AC) (deltax = 0.3+/-0.29 mm and deltay = 0.34+/-0.32 mm) and posterior commissure (PC) (deltax = 0.15+/-0.18 mm and deltay = 0.34+/-0.25 mm); 2) pre- and postoperative AC-PC distance (deltaL = 0.33+/-0.22 mm); and 3) preoperative target and final electrode position coordinates (deltax = 0.24+/-0.22 mm; deltay = 0.19+/-0.16 mm).

CONCLUSIONS

In the authors' center, MR imaging distortions did not induce detectable errors during stereotactic surgery in dystonic children. Target localization and electrode implantation could be achieved using MR imaging alone after induction of general anesthesia. The remarkable postoperative improvement in these patients confirmed the accuracy of the procedure (Burke-Marsden-Fahn Dystonia Rating Scale score delta = -83.8%).

摘要

目的

给定系列磁共振（MR）图像中存在的实际失真难以确定。本研究的目的是验证一种基于MR成像的方法，用于在全身麻醉诱导下对儿童进行电极植入时立体定向靶向内侧苍白球。

方法

12名患有全身性肌张力障碍的儿童（平均随访1年）通过使用头架和MR成像接受了深部脑刺激治疗。为了分析该过程每个步骤中失真的影响，首先使用定位器作为模型来控制框架的几何特征。然后，对固定解剖标志和电极位置的术前和术后坐标进行统计比较，两者均在头架就位时确定。在x、y和z方向上，定位器的理论尺寸与测量尺寸之间未观察到显著差异（学生t检验，12例患者的“t”>2.2）。在以下各项之间未观察到显著差异（Wilcoxon配对样本检验）：1）前连合（AC）的术前和术后坐标（Δx = 0.3±0.29 mm，Δy = 0.34±0.32 mm）和后连合（PC）的术前和术后坐标（Δx = 0.15±0.18 mm，Δy = 0.34±0.25 mm）；2）术前和术后AC-PC距离（ΔL = 0.33±0.22 mm）；3）术前靶点和最终电极位置坐标（Δx = 0.24±0.22 mm；Δy = 0.19±0.16 mm）。