磁共振定位在帕金森病立体定向手术中的应用

Magentic resonance imaging guided target localization in stereotactic neurosurgery of Parkinsons disease.

目的 探讨磁共振 (MR)定位功能性立体定向手术的精确性及可靠性。方法 1 0 0例帕金森病患者 ,术前行磁共振检查。选择丘脑Vim核、Gpi为手术靶点。采用正中矢状位T1 加权像 ,轴位、冠状位T1 成像及加权反向恢复序列扫描。手术后整体疗效评价 ,“开”状态改善率为 79 7% ,“关”状态改善 91 3%。结果 MR能清晰显示丘脑、Gpi、视束、内囊等重要结构 ,靶点定位准确。结论 ①MR组织分辨率高、能清晰显示靶点区重要结构 ,达到直接解剖定位。②MR严格按照正中矢状位以及平行于头架的轴位成像。③在直视解剖靶点下直接测出数据 ,而不是采用传统的图谱坐标。④保证立体定向仪平行于AC -PC线、缩短手术时间、减少脑脊液外流的措施 。

Objective To assess the accuracy and reliability functional stereotactic neurosurgery.Methods In 100 consecutive patients with Parkinsons disease, thalamotomy of Vim nuclei and globus or pallidus internal(Gpi)was performed magnetic resonance(MR) T1-weighted imaging and reverse recovery-sequence scance in the axial and coronal plane were applied for the target coordinates calculation.Results After operation, the rate of improvement was 79.7% for 'off ' states and 91.3% for 'on' states.MR imaging shown clearly the ventralis lateral structures of thalamus, optic tract, internal capsule, and its abjacent structutes.Conclusion MR imaging provides direct anatomic localization of the target important structures. MR imaging is performed in the axial plane parallel to the AC-PC line and stereotactic head frame.The target coordinates date can be directly teadout, calculated, while it can not be done by the conventional cerebral atlas.It is important to maintain the stereotactic head frame parallel to the AC-PC line, to reduce the surgical time as short as possible to prevent the cerebrospinal fluid leakage, and to ensure optimal was accuracy of surgical target.