MR导向丘脑、苍白球毁损治疗锥体外系疾病

MR-guided stereotactic thalamotomy and posteroventral pallidotomy for extrapyrami-dal disease

从１９９５年１０月～１９９６年５月，我们使用Ｌｅｋｓｅｌｌ－Ｇ型定向仪，１．０ｔｅｓｌａ超导磁共振导向，对３４例（男２１例，女１３例）锥体外系疾病（ＰＤ２７例，扭转痉挛３例，意向性震颤４例）进行靶点毁损术，通过临床效果和术前、后ＭＲ复查，证实ＭＲ导向三维误差＜１ｍｍ，ＭＢＩ导向的功能性神经外科疾病治疗，几何图像失真小，清晰，靶点易辨认，术后反应小，若在电生理监测下更安全、有效。

uring past two years, 34 cases (21 male, 13 female) of extrapyramidal disease underwent MR-guidedstereotactic thalamotomy or posteroventral pallidotomy. Among them. 27 cases were parkinson’s disease.4 cases were intention tremor and 3 cases were torsion spasm.All patients underwent fixation of a MR-compatible Leksell Mode G frame. MR was performed on a1.0 Tesla MR mnachine. Fov was 28cm and matrix 256 × 256. Images were 3mm in thickness. The protonaxial imakres and the mid-sagittal T1 or T2-Weighted SE images were chosen for target calculation. Thepositoion of radiofrequency probe (1.4 ×4mm) was determind intraoperatively by electrical stimulationtrial. Thermal lesions were made at 70～75% ℃ for 100'.31 cases (parkinson's tremor and intention trmor) except one get complete relief of tremor, butwho the akinesia and rigidity was improved remarkably as well. The major deficiency is there is a lmmdifference between the images of the lesion (7 day after opreation) and that on the MR flem. but one casewas 3mm on the X-axis.Stereotactic MR allows artiftset-free visualizatiou with high resolution, direct multiplariar imagingwithout reformatting.Furthermore. direct selection and calculation of target coordinate in proper planeenables one to measure the distance between target,and internal capsule prior to surgery. This studysupports MR. guidance for stereotaxitic functional neurosurgery as an accurate. easily performed method.