Hamani Clement, Richter Erich O, Andrade-Souza Yuri, Hutchison William, Saint-Cyr Jean A, Lozano Andres M
Division of Neurosurgery, University of Toronto, Toronto, ON M5T 2S8, Canada.
Surg Neurol. 2005 Mar;63(3):249-53; discussion 253. doi: 10.1016/j.surneu.2004.05.036.
Magnetic resonance imaging (MRI) and microelectrode recording (MER) are commonly used to guide stereotactic procedures on the subthalamic nucleus (STN). Little is known about the correlation between the position of the STN as seen on MRI and that as determined by MER mapping. We compared these in 10 patients with Parkinson's disease.
The position of the STN was determined by intraoperative MER findings and stereotactic axial T2 magnetic resonance images with 2-mm slice thickness. Images were reconstructed in a 3-dimensional workstation. The anterior, posterior, medial, lateral, dorsal, and ventral borders of the STN defined with the MRI were measured relative to the midcommissural point. The location of STN activity during MER was reconstructed relative to the midcommissural point for comparison.
Twenty-nine tracks recorded with microelectrodes provided clear spans of STN-like activity in 18 STN nuclei. The coordinates of MER were, in general, within the borders of the STN defined with the MRI. However, when analyzed individually, some of the tracks had STN-like activity outside the borders of the MRI-defined nucleus (mostly <1 mm). Three tracks had STN-like activity recorded between 2 and 3 mm more anterior than the anterior border of the nucleus defined with the MRI.
There was a good correlation between MER and the borders of the STN defined in the MRI, except for the anterior-posterior axis, in which MER indicated that the STN extended more anteriorly than as suggested by MRI. This should be taken into account in STN surgery.
磁共振成像（MRI）和微电极记录（MER）常用于指导丘脑底核（STN）的立体定向手术。关于MRI上所见的STN位置与MER测绘确定的位置之间的相关性，目前了解甚少。我们对10例帕金森病患者进行了比较。
通过术中MER结果和层厚2毫米的立体定向轴向T2磁共振图像确定STN的位置。图像在三维工作站上重建。相对于连合中点测量MRI定义的STN的前、后、内、外、背和腹侧边界。将MER期间STN活动的位置相对于连合中点进行重建以作比较。
用微电极记录的29条轨迹在18个STN核中提供了清晰的类STN活动范围。MER的坐标总体上在MRI定义的STN边界内。然而，单独分析时，一些轨迹在MRI定义的核边界之外有类STN活动（大多<1毫米）。三条轨迹记录的类STN活动比MRI定义的核的前边界靠前2至3毫米。
除前后轴外，MER与MRI定义的STN边界之间存在良好的相关性，在前后轴上，MER显示STN比MRI所示的更靠前。在STN手术中应考虑到这一点。
