Obwegeser A A, Uitti R J, Lucas J A, Witte R J, Turk M F, Galiano K, Wharen R E
Department of Neurosurgery, Mayo Clinic Jacksonville, Florida, USA.
Br J Neurosurg. 2008 Oct;22(5):654-62. doi: 10.1080/02688690802256381.
The purpose of this study was the development of a new method to correlate functional surgery with outcome measures. Lesions following microelectrode guided globus pallidus internus (GPi) pallidotomy for Parkinson's disease are presented to demonstrate this new method in regard to clinical outcome. A clinical series of 26 patients with extensive neurological and neuropsychological data were studied. Three-month postoperative MRI lesion borders at the AC-PC plane were scaled to a standard size, and the lesions were stored in a virtual array with a cell size of one voxel. The average outcome measure for each voxel is presented graphically. Unified Parkinson's disease rating scale (UPDRS) motor scores improved more with posterolateral and centrally located GPi lesions than with anteromedial lesions. A correlation of lesion location to outcome was also visible for subscales of the UPDRS. The distributions were similar for the left and right sides, as well as for ipsi- and contralateral measurements. In general, verbal fluency decreased after lesioning the dominant hemisphere, and posterolateral lesions caused less impairment. This method enables associative analyses between brain area and outcome down to the size of a few voxels. This may be particularly helpful for planning and validating neurosurgical targets for various disorders.
本研究的目的是开发一种将功能性手术与结果指标相关联的新方法。本文展示了帕金森病患者在微电极引导下进行内侧苍白球（GPi）苍白球切开术后的病变情况，以说明这种关于临床结果的新方法。对26例具有广泛神经学和神经心理学数据的患者进行了临床系列研究。术后三个月在AC-PC平面的MRI病变边界被缩放到标准大小，病变被存储在一个体素大小为一个单元的虚拟阵列中。每个体素的平均结果指标以图形方式呈现。与内侧病变相比，位于后外侧和中央的GPi病变使统一帕金森病评定量表（UPDRS）运动评分改善得更多。UPDRS各亚量表的病变位置与结果之间也存在相关性。左右两侧以及同侧和对侧测量的分布相似。一般来说，损伤优势半球后言语流畅性下降，而后外侧病变造成的损害较小。这种方法能够对小至几个体素大小的脑区与结果进行关联分析。这对于规划和验证各种疾病的神经外科靶点可能特别有帮助。
