Dormont D, Cornu P, Pidoux B, Bonnet A M, Biondi A, Oppenheim C, Hasboun D, Damier P, Cuchet E, Philippon J, Agid Y, Marsault C
Department of Neuroradiology, Salpêtrière Hospital, Paris VI University, France.
AJNR Am J Neuroradiol. 1997 Jun-Jul;18(6):1093-107.
To report a method of electrode implantation in the ventralis intermedius nucleus of the thalamus for the treatment of tremor using a 3-D stereotactic MR imaging technique.
Five patients (three men and two women; mean age, 59 years) with medically refractory tremor had intrathalamic implantation of a stimulating electrode. Stereotactic MR imaging was performed on a 1.5-T unit equipped with an MR-compatible Leksell G stereotactic frame fixed to the patient's head. Calculation of the coordinates of the theoretical target was based on the coordinates of the anterior commissure, the posterior commissure, and the midline sagittal plane as determined via stereotactic MR imaging. During the surgical procedure, the best position for the stimulating electrode was determined by electrophysiological and clinical studies. Postoperative MR control studies were done in all cases to verify the position of the electrode.
Stereotactic MR imaging allowed precise implantation of the stimulating electrode in all patients. Electrode stimulation produced a 90% reduction of the tremor in two patients, an 80% and 70% reduction in one patient each, and a persistent microthalamotomy-like effect in the fifth patient. Examination of the MR control studies showed that mean error in the positioning of the electrodes was 0.77 +/- 0.6 mm (mean +/- SD) in the x direction and 0.80 +/- 1.02 mm in the y direction.
Although our series is relatively small, the precision achieved with stereotactic MR imaging proves that it can be used with confidence for precise functional neurosurgical procedures.
报告一种使用三维立体定向磁共振成像技术在丘脑腹中间核植入电极治疗震颤的方法。
5例（3男2女；平均年龄59岁）药物难治性震颤患者接受了丘脑内刺激电极植入。在配备与磁共振兼容的Leksell G立体定向框架并固定于患者头部的1.5-T设备上进行立体定向磁共振成像。基于通过立体定向磁共振成像确定的前连合、后连合及中线矢状面的坐标来计算理论靶点的坐标。手术过程中，通过电生理和临床研究确定刺激电极的最佳位置。所有病例均进行了术后磁共振对照研究以核实电极位置。
立体定向磁共振成像使所有患者的刺激电极得以精确植入。电极刺激使2例患者的震颤减轻90%，1例患者减轻80%，另1例患者减轻70%，第5例患者出现持续的类似微丘脑切开术的效果。磁共振对照研究检查显示，电极定位在x方向的平均误差为0.77±0.6 mm（均值±标准差），在y方向为0.80±1.02 mm。
尽管我们的病例系列相对较小，但立体定向磁共振成像所达到的精度证明它可放心用于精确的功能神经外科手术。
