CAJ | 학술논문

目的探讨帕金森病(PD)丘脑腹中间核(Vim)毁损术中靶点的定位方法.方法回顾性分析34例行Vim毁损的PD患者的临床资料及定位方法,即术中测量MRI定位片中第三脑室宽度、AC-PC线的长度,并据此对标准靶点的坐标做出相应调整,再通过术中电生理刺激对靶点位置进行二次调整.结果 34例患者的平均连合间径长度及第三脑室宽度与立体定向图谱中的相应数值差异有统计学意义(P ＜0.001).其中9例根据MRI定位片对靶点进行预调整,电生理刺激有7例参数满意,2例行二次调整;余25例电刺激后有6例进行二次调整.术后所有患者震颤明显改善.结论根据MRI定位片中第三脑室宽度及连合间径长度结合标准脑立体定向解剖图谱对Vim进行预定位,再通过术中电生理刺激对靶点位置进行调整,可提高靶点定位的精确性及手术疗效.
목적 탐토파금삼병(PD)구뇌복중간핵(Vim)훼손술중파점적정위방법.방법 회고성분석34례행Vim훼손적PD환자적림상자료급정위방법,즉술중측량MRI정위편중제삼뇌실관도、AC-PC선적장도,병거차대표준파점적좌표주출상응조정,재통과술중전생리자격대파점위치진행이차조정.결과 34례환자적평균련합간경장도급제삼뇌실관도여입체정향도보중적상응수치차이유통계학의의(P ＜0.001).기중9례근거MRI정위편대파점진행예조정,전생리자격유7례삼수만의,2례행이차조정;여25례전자격후유6례진행이차조정.술후소유환자진전명현개선.결론 근거MRI정위편중제삼뇌실관도급련합간경장도결합표준뇌입체정향해부도보대Vim진행예정위,재통과술중전생리자격대파점위치진행조정,가제고파점정위적정학성급수술료효.
Objective To explore the method of targeting the ventralis intermediate nucleus in stereotactic lesion of PD.Methods Thirty-four PD patients had a operation with stereotactic lesion on the vim nucleus,which clinical datas were retrospectively reviewed.The width of the third ventricle and the length of the AC-PC line were measured of each patient during operation.According to the results,standard coordinates of the target was adjusted accordingly when necessary and then was readjusted through electrophysiological stimulation.Results MRI-derived measurements of the average AC-PC distance and the average width of the third ventricle were compared to Schaltenbrand and Wahren Atlas,the differences were statistically significant(P ＜0.001).Standard coordinates of the target was adjusted in nine patients according to the MRI positioning pieces,7 of them had satisfactory electrophysiological parameters during electrophysiological stimulation,and other 2 of them received readjustment of the target.There were 6 patients experienced readjustment of the target by electrophysiological stimulation in the rest of he 25 patients.The symptom of tremor was alleviated in all patients.Conclusion Preliminary localization to the vim nucleus according to the width of third ventricle and the length of AC-PC line from MRI positioning pieces combined with the standard stereotactic anatomical atlas and readjust the target rely on electrophvsiological stimulation can enhance the precision of location and surgical outcomes.