Lefranc Michel, Derrey Stéphane, Merle Philippe, Tir Mélissa, Constans Jean-Marc, Montpellier Dominique, Macron Jean Michel, Le Gars Daniel, Peltier Johan, Baledentt Olivier, Krystkowiak Pierre
Departments of *Neurosurgery, ‡Functional Exploration of the Central Nervous System, §Neurology, ¶Neuroradiology, ‖Anesthesiology, Amiens University Medical Center, Amiens, France; #Department of Neurosurgery, Rouen University Medical Center, Rouen, France.
Neurosurgery. 2014 Jun;74(6):615-26; discussion 627. doi: 10.1227/NEU.0000000000000319.
Subthalamic nucleus deep brain stimulation (STN-DBS) is an established treatment for Parkinson's disease.
To characterize an optimized magnetic resonance imaging (MRI) sequence (high-resolution 3-dimensional T2*-weighted angiography [HR 3-D SWAN]) for direct STN targeting.
Sequence distortions were measured using the Leksell stereotactic phantom. Eight consecutive candidates for STN-DBS underwent HR 3-D SWAN MRI for direct identification of the 16 STN. Two senior neurosurgeons independently determined the boundaries of STN on a semiquantitative scale (ranging from 1 [identification very easy] to 4 [identification very difficult]) and the anatomic target within the nucleus. The anatomic data were compared with electrophysiological recordings (48 microrecordings). We examined the anatomic location of the active contacts on MRI.
The mean distortion error over the phantom was 0.16 mm. For the 16 STNs, identification of the upper, internal, anterior, and external edges was considered to be easy (scores of 1 or 2). The distinction between the substantia nigra and the STN was rated 1 or 2 for all but 6 nuclei. In the mediolateral axis, electrophysiological recordings covered perfectly anatomic data. In the craniocaudal axis, the mean differences between the electrophysiological data and the anatomic data were 0.8 mm and 0.19 mm for the "entry" and "exit" of the STN, respectively. All active contacts were located within the STN on MRI.
HR 3-D SWAN allows easy visualization of the STN. Adapted to stereotactic requirement, the sequence simplifies direct targeting in STN-DBS surgery.
丘脑底核深部脑刺激术（STN-DBS）是帕金森病的一种既定治疗方法。
确定一种用于直接靶向丘脑底核的优化磁共振成像（MRI）序列（高分辨率三维T2*加权血管造影术[HR 3-D SWAN]）。
使用Leksell立体定向体模测量序列畸变。连续8名STN-DBS候选患者接受HR 3-D SWAN MRI检查，以直接识别16个丘脑底核。两名资深神经外科医生独立以半定量量表（范围从1[识别非常容易]到4[识别非常困难]）确定丘脑底核的边界以及核内的解剖靶点。将解剖数据与电生理记录（48次微记录）进行比较。我们在MRI上检查了有源触点的解剖位置。
体模上的平均畸变误差为0.16毫米。对于16个丘脑底核，识别其上缘、内侧缘、前缘和外侧缘被认为是容易的（评分为1或2）。除6个核外，黑质与丘脑底核之间的区分评分为1或2。在内外侧轴上，电生理记录完美覆盖了解剖数据。在头尾轴上，丘脑底核“入口”和“出口”处的电生理数据与解剖数据之间的平均差异分别为0.8毫米和0.19毫米。所有有源触点在MRI上均位于丘脑底核内。
HR 3-D SWAN能轻松显示丘脑底核。该序列适应立体定向要求，简化了STN-DBS手术中的直接靶向操作。
