Department of Neurosurgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
Acta Neurochir (Wien). 2011 Dec;153(12):2307-18. doi: 10.1007/s00701-011-1081-7. Epub 2011 Jul 9.
The aim of our study was to evaluate discrepancies between the electrophysiologically and MRI-defined subthalamic nucleus (STN) in order to contribute to the ongoing debate of whether or not microelectrode recording (MER) provides additional information to image-guided targeting in deep brain stimulation.
Forty-four STNs in 22 patients with Parkinson's disease were investigated. The three-dimensional MRI-defined STN was derived from segmentations of axial and coronal T2-weighted images. The electrophysiological STNs were generated from intraoperative MERs in 1,487 locations. The stereotactical coordinates of positive and negative STN recordings were re-imported to the planning software, where a three-dimensional reconstruction of the electrophysiological STN was performed and fused to the MRI data set. The estimated borders of the MRI- and MER-STN were compared. For statistical analysis Student's t, Mann-Whitney rank sum and Fisher's exact tests were used.
MER-STN volumes, which were found outside the MRI-STN, ranged from 0 mm(3) to 87 mm(3) (mean: 45 mm(3)). A mean of 44% of the MER-STN volumes exceeded the MRI-STN (maximum: 85.1%; minimum: 15.1 %); 53.4% (n = 793) of the microelectrode recordings were concordant and 46.6% (n = 694) discordant with the MRI-defined anatomical STN. Regarding the dorsal borders, we found discrepancies between the MER- and MRI-STN of 0.27 mm (= mean; SD: 0.51 mm) on the first operated side and 1.51 mm (SD: 1.5 mm) on the second (p = 0.010, t-test).
MER provides additional information to high-resolution anatomical MR images and may help to detect the amount and direction of brain shift.
我们研究的目的是评估电生理和 MRI 定义的丘脑底核（STN）之间的差异，以便为正在进行的关于微电极记录（MER）是否为深部脑刺激的图像引导靶点提供额外信息的争论做出贡献。
研究纳入了 22 例帕金森病患者的 44 个 STN。三维 MRI 定义的 STN 源自轴向和冠状 T2 加权图像的分割。电生理 STN 是从术中 MER 的 1487 个位置产生的。正性和负性 STN 记录的立体定向坐标被重新导入到规划软件中，在该软件中，对电生理 STN 进行三维重建并与 MRI 数据集融合。比较了 MRI 和 MER-STN 的估计边界。统计学分析采用学生 t 检验、Mann-Whitney 秩和检验和 Fisher 精确检验。
MER-STN 体积超出 MRI-STN 的范围为 0 mm(3) 至 87 mm(3)（平均：45 mm(3)）。MER-STN 体积的平均值有 44%（最大：85.1%；最小：15.1%）超出了 MRI-STN；53.4%（n = 793）的微电极记录与 MRI 定义的解剖 STN 一致，46.6%（n = 694）的微电极记录与 MRI 定义的解剖 STN 不一致。关于背侧边界，我们发现 MER-和 MRI-STN 之间存在差异，第一次手术侧为 0.27 mm（平均值；标准差：0.51 mm），第二次手术侧为 1.51 mm（标准差：1.5 mm）（p = 0.010，t 检验）。
MER 为高分辨率解剖 MRI 图像提供了额外的信息，并可能有助于检测脑移位的程度和方向。
