深部脑刺激治疗帕金森病:下丘脑核团靶点定位的解剖与生理对比研究

Deep brain stimulation for Parkinson's disease: Targeting subthalamic nucleus, anatomy versus physiology

目的 探讨脑深部STN刺激靶点时MRI直接定位法和MER术中导引定位法的解剖学偏差。方法 本组5例帕金森病患者,分别表现为运动迟缓、步态不稳及躯干症状,共安放6例次微电极。结果 采用MRI直接定位法和MER术中导引定位法,其定位靶点的平均偏差距离是1.25mm,尽管该偏差值较小,但是,基于影像学的立体定向法只能将刺激电极定位于距离靶点几毫米的范围内。结论 电生理学方法（MER）对于调整和确定靶点位置至关重要。MER术中导引定位法有助于手术的完全成功。

Objective To study intraoperatively the anatomical discrepancy between MRI direct targeting and MER-guided targeting for deep brain stimulation of the STN. Methods Five patients with predominant akinesia, gait disturbance and axial symptoms were included in this study and six electrodes were placed. Results The mean discrepancy between the MRI-and MER-guided targets was 1. 25 mm. Although the discrepancy between the MRI-and MER-guided targeting was small, image-guided stereotaxis alone was only adequate for placing the electrode within several millimeters of the target. Conclusion Electrophysiological study ( microelectrode recording) is vital to the adjustment and determination of the final placement. The MER-guided procedure gives the team the confidence of 100% success.