Heilbrun M P, Koehler S, McDonald P, Faour F
Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, USA.
Stereotact Funct Neurosurg. 1997;69(1-4 Pt 2):19-27. doi: 10.1159/000099850.
From October 1992 through December 1996, we performed 109 ventroposterolateral pallidotomies on 104 patients with Parkinson's disease. Throughout the series, we have used the basic imaging technique described by Laitinen, utilizing impedance measurement and macrostimulation to determine the optimal target position within with the pallidum and avoid the optic tract and the internal capsule. To take advantage of the high resolution of MR imaging while compensating for potential MR distortion, we have refined our stereotactic software to accomplish effective cross-registration and reformatting of CT and MR images. By 1995, several centers were suggesting that optimal target localization required microelectrode identification of pallidal neuronal firing patterns. During 1996, we performed microelectrode recording in 13 of the 25 patients undergoing pallidotomy. We have concluded that the basic technique of Laitinen, coupled with high-resolution imaging remains the foundation for achieving effective pallidotomy. Microelectrode recording is a useful adjunct to identify hyperactive firing patterns in the internal pallidum and, coupled with impedance measurements and macrostimulation, can define the lower border of the pallidum.
从1992年10月到1996年12月，我们对104例帕金森病患者实施了109次腹后外侧苍白球切开术。在整个系列手术中，我们采用了莱蒂宁所描述的基本成像技术，利用阻抗测量和宏观刺激来确定苍白球内的最佳靶点位置，并避开视束和内囊。为了利用磁共振成像（MR）的高分辨率，同时补偿潜在的MR图像失真，我们改进了立体定向软件，以实现CT和MR图像的有效交叉配准和重新格式化。到1995年，几个中心提出，最佳靶点定位需要通过微电极识别苍白球神经元放电模式。1996年，在接受苍白球切开术的25例患者中，我们对其中13例进行了微电极记录。我们得出结论，莱蒂宁的基本技术，结合高分辨率成像，仍然是实现有效苍白球切开术的基础。微电极记录是一种有用的辅助手段，可用于识别苍白球内的过度活跃放电模式，并且与阻抗测量和宏观刺激相结合，可以确定苍白球的下边界。
