Danish Shabbar F, Jaggi Jurg L, Moyer Jason T, Finkel Leif, Baltuch Gordon H
Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19107, USA.
Stereotact Funct Neurosurg. 2006;84(1):12-8. doi: 10.1159/000092682. Epub 2006 Apr 19.
An understanding of the relationships between the anterior commissure-posterior commissure line (AC-PC), the subthalamic nucleus (STN), and red nucleus (RN) is imperative if these structures are to be used for targeting in deep brain stimulation. Currently, these relationships are incompletely understood and difficult to assess using conventional MRI. We examined the location and relationships of the STN and the RN to the AC-PC line and to each other in order to provide a greater understanding of their utility when targeting the STN, and the consistency of these anatomic relationships when examined using conventional MRI.
A total of 52 STN and RN in 26 patients with Parkinson's disease were evaluated on T2-weighted MR images. The anterior and posterior commissures and the border coordinates of the STN and RN were derived using frame coordinates. The distances from the midcommissural point (mcp) to the centers of the STN and RN, the diameters for each nucleus, and the distances between the nuclei were calculated in the x-, y-, and z-axes.
The mean AC-PC length was 26.1 +/- 1.3 mm. The distance from the mcp to the center of the STN was 10 +/- 0.7 mm in the x-axis, 0.2 +/- 0.7 mm in the y-axis, and 3.3 +/- 0.9 mm in the z-axis. The distance from the mcp to the center of the RN was 4.7 +/- 0.6 mm in the x-axis, -5.9 +/- 1.0 mm in the y-axis, and 6.1 +/- 1.3 mm in the z-axis. The distance between the STN and RN was 2.3 +/- 0.7 mm in the x-axis, 2.1 +/- 1.0 mm in the y-axis, and -0.2 +/- 1.3 mm in the z-axis.
Although recent studies imply that the RN can be used as a relatively consistent marker for the position of the STN, the present data suggest otherwise. These data indicate that a single targeting method may be inadequate given the resolution of conventional MRI, and that it is imperative to use multiple anatomical measurements when targeting the STN for deep brain stimulation in Parkinson's disease.
如果要将前连合-后连合线（AC-PC）、丘脑底核（STN）和红核（RN）这些结构用于深部脑刺激的靶点定位，那么了解它们之间的关系至关重要。目前，这些关系尚未完全明确，且使用传统磁共振成像（MRI）难以评估。我们研究了STN和RN相对于AC-PC线的位置及它们彼此之间的关系，以便更好地理解在以STN为靶点时它们的作用，以及使用传统MRI检查时这些解剖关系的一致性。
对26例帕金森病患者的52个STN和RN在T2加权磁共振图像上进行评估。使用框架坐标得出前连合和后连合以及STN和RN的边界坐标。计算在x、y和z轴上从中连合点（mcp）到STN和RN中心的距离、每个核的直径以及核之间的距离。
AC-PC的平均长度为26.1±1.3毫米。在x轴上，从mcp到STN中心的距离为10±0.7毫米，在y轴上为0.2±0.7毫米，在z轴上为3.3±0.9毫米。在x轴上，从mcp到RN中心的距离为4.7±0.6毫米，在y轴上为 -5.9±1.0毫米，在z轴上为6.1±1.3毫米。在x轴上，STN和RN之间的距离为2.3±0.7毫米，在y轴上为2.1±1.0毫米，在z轴上为 -0.2±1.3毫米。
尽管最近的研究表明RN可作为STN位置的相对一致的标志物，但目前的数据表明并非如此。这些数据表明，鉴于传统MRI的分辨率，单一靶向方法可能并不充分，在帕金森病深部脑刺激中以STN为靶点时，必须使用多种解剖测量方法。
