一种使用高场磁共振成像的新型复合靶向方法用于丘脑底核深部脑刺激。
A novel composite targeting method using high-field magnetic resonance imaging for subthalamic nucleus deep brain stimulation.
作者信息
Toda Hiroki, Sawamoto Nobukatsu, Hanakawa Takashi, Saiki Hidemoto, Matsumoto Sadayuki, Okumura Ryosuke, Ishikawa Masatsune, Fukuyama Hidenao, Hashimoto Nobuo
机构信息
Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Japan.
出版信息
J Neurosurg. 2009 Oct;111(4):737-45. doi: 10.3171/2008.12.JNS0861.
OBJECT
Accurate localization of the subthalamic nucleus (STN) is important for proper placement of the electrodes in deep brain stimulation (DBS) surgery for patients with advanced Parkinson disease. The authors evaluated the accuracy of our modified composite targeting method and the value of using high-field MR imaging for targeting the STN.
METHODS
Thirteen patients with advanced Parkinson disease underwent bilateral STN DBS based on 3-T MR imaging, and 13 patients underwent surgery based on 1.5-T MR imaging. By sequentially referring to the postmammillary commissure, the red nucleus, the mammillothalamic tract, and the STN, the modified composite targeting method determined the stereotactic coordinates for targeting the STN. The accuracy and efficacy of the composite targeting method and 3-T MR imaging were evaluated by using the intraoperative microelectrode recording, the postoperative imaging study, and the postoperative clinical improvement.
RESULTS
The landmark structures for targeting the STN were visualized clearly with 3-T MR imaging. The mean (+/- SD) path length through the STN of the central track was 4.9 +/- 1.1 mm in the 3-T group and 3.1 +/- 2.0 mm in the 1.5-T group (p < 0.001). Twenty-one (81%) of 26 electrodes were placed in the central track in the 3-T group, whereas 8 (31%) of 26 electrodes were placed in the central track in the 1.5-T group (p = 0.006). The rest of the electrodes were placed in the noncentral optimum track for alleviating parkinsonian motor symptoms. The mean Unified Parkinson's Disease Rating Scale motor part score during off period was reduced by 53% in the 3-T group and by 41% in the 1.5-T group (p = 0.14). The mean reductions of levodopa equivalent daily doses were 48.6% in the 3-T group and 43.7% in the 1.5-T group (p = 0.61).
CONCLUSIONS
The use of the modified composite targeting method referring to the multiple landmarks with 3-T MR imaging offers reliable and clinically effective target for STN DBS surgery.
目的
对于晚期帕金森病患者，在脑深部电刺激（DBS）手术中准确放置电极，丘脑底核（STN）的精确定位很重要。作者评估了改良复合靶点定位方法的准确性以及使用高场强磁共振成像（MR）对STN进行靶点定位的价值。
方法
13例晚期帕金森病患者基于3-T MR成像接受双侧STN-DBS手术，13例患者基于1.5-T MR成像接受手术。改良复合靶点定位方法通过依次参照乳头体后连合、红核、乳头丘脑束和STN来确定STN的立体定向坐标。通过术中微电极记录、术后影像学检查和术后临床改善情况来评估复合靶点定位方法及3-T MR成像的准确性和有效性。
结果
3-T MR成像能清晰显示STN的标志性结构。3-T组中央轨迹穿过STN的平均（±标准差）路径长度为4.9±1.1 mm，1.5-T组为3.1±2.0 mm（p<0.001）。3-T组26根电极中有21根（81%）置于中央轨迹，而1.5-T组26根电极中有8根（31%）置于中央轨迹（p=0.006）。其余电极置于非中央最佳轨迹以缓解帕金森运动症状。3-T组关期平均统一帕金森病评定量表运动部分评分降低53%，1.5-T组降低41%（p=0.14）。左旋多巴等效日剂量平均减少量在3-T组为48.6%，1.5-T组为43.7%（p=0.61）。
结论
采用改良复合靶点定位方法并结合3-T MR成像的多个标志性结构可为STN-DBS手术提供可靠且临床有效的靶点。
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