Cuny Emmanuel, Guehl Dominique, Burbaud Pierre, Gross Christian, Dousset Vincent, Rougier Alain
Service de Neurochirurgie, Höpital Pellegrin, Bordeaux, France.
J Neurosurg. 2002 Sep;97(3):591-7. doi: 10.3171/jns.2002.97.3.0591.
The goal of this study was to determine the most suitable procedure(s) to localize the optimal site for high-frequency stimulation of the subthalamic nucleus (STN) for the treatment of advanced Parkinson disease.
Stereotactic coordinates of the STN were determined in 14 patients by using three different methods: direct identification of the STN on coronal and axial T2-weighted magnetic resonance (MR) images and indirect targeting in which the STN coordinates are referred to the anterior commissure-posterior commissure (AC-PC) line, which, itself, is determined either by using stereotactic ventriculography or reconstruction from three-dimensional (3D) MR images. During the surgical procedure, electrode implantation was guided by single-unit microrecordings on multiple parallel trajectories and by clinical assessment of stimulations. The site where the optimal functional response was obtained was considered to be the best target. Computerized tomography scanning was performed 3 days later and the scans were combined with preoperative 3D MR images to transfer the position of the best target to the same system of stereotactic coordinates. An algorithm was designed to convert individual stereotactic coordinates into an all-purpose PC-referenced system for comparing the respective accuracy of each method of targeting, according to the position of the best target.
The target that is directly identified by MR imaging is more remote (mainly in the lateral axis) from the site of the optimal functional response than targets obtained using other procedures, and the variability of this method in the lateral and superoinferior axes is greater. In contrast, the target defined by 3D MR imaging is closest to the target of optimal functional response and the variability of this method is the least great. Thus, 3D reconstruction adjusted to the AC-PC line is the most accurate technique for STN targeting, whereas direct visualization of the STN on MR images is the least effective. Electrophysiological guidance makes it possible to correct the inherent inaccuracy of the imaging and surgical techniques and is not designed to modify the initial targeting.
本研究的目的是确定最合适的方法来定位丘脑底核（STN）高频刺激的最佳部位，用于治疗晚期帕金森病。
通过三种不同方法在14例患者中确定STN的立体定向坐标：在冠状位和轴位T2加权磁共振（MR）图像上直接识别STN，以及间接靶向，其中STN坐标参考前连合-后连合（AC-PC）线，而AC-PC线本身通过立体定向脑室造影或三维（3D）MR图像重建来确定。在手术过程中，电极植入通过多条平行轨迹上的单单位微记录和刺激的临床评估来引导。获得最佳功能反应的部位被认为是最佳靶点。术后3天进行计算机断层扫描，并将扫描结果与术前3D MR图像相结合，将最佳靶点的位置转换到相同的立体定向坐标系统。设计了一种算法，根据最佳靶点的位置，将个体立体定向坐标转换为通用的以PC为参考的系统，以比较每种靶向方法的各自准确性。
与使用其他方法获得的靶点相比，通过MR成像直接识别的靶点离最佳功能反应部位更远（主要在横轴方向），并且该方法在横轴和上下轴方向的变异性更大。相比之下，由3D MR成像定义的靶点最接近最佳功能反应靶点，并且该方法的变异性最小。因此，根据AC-PC线调整的3D重建是STN靶向最准确的技术，而在MR图像上直接可视化STN是最无效的。电生理引导能够纠正成像和手术技术固有的不准确性，并且并非旨在修改初始靶向。
