解剖定位与功能定位相结合手术治疗帕金森病(附21例报道)

Anatomical location combined with functional location for the surgical treatment of Parkinson’s disease:report of 21 cases

目的探讨术前MRI解剖定位与术中MER功能定位相结合立体定向脑深部电刺激手术治疗帕金森病的安全性和有效性。方法本组男8例,女13例,年龄46~74岁,平均64.38岁。病程6~15年,平均7.86年。临床分型:僵直为主型10例,僵直-震颤混合型11例。按照Hoehn&Yahr分级:III级6例,IV级15例。所有患者术前均先在MRI上行双侧底丘脑的解剖定位,术中再结合MER功能定位调整手术靶点,确认无误后行脑深部电刺激手术,术后均随访1年以上以观察手术的疗效。结果21例患者术前在MRI上均能准确定位双侧底丘脑的解剖位置,术中有10例患者在MER功能定位下调整了手术靶点,调整的位置均在对侧靶点。所有患者手术过程均顺利,平均用时3.51±1.23 h,共置入42根刺激电极。术后一周复查MRI提示靶点位置均良好。术后1年以上随访发现21例患者的运动症状改善率为41.25~87.64%,平均60.24±4.35%。术后LDE明显低于术前(P<0.05);术后开机状态下(服药和未服药)UPDRS-Ⅲ评分明显低于术前(P<0.05)。结论术前MRI解剖定位与术中MER功能定位相结合能够提高脑深部电刺激手术的疗效,是中晚期帕金森病患者一种安全有效的手术方法。

Objective To explore the safety and efficancy on pre-operative MRI anatomical location combined with intra-operative micro-electrode recording(MER)functional location for the surgical treatment of Parkinson’s disease.Methods There were 8 males and 13 females in this group.Their ages ranged from 46 to 74 years(mean 64.38 years).Their illness duration ranged from 6 to 15 years(mean 7.68 years).The clinical classification showed rigidity-type in 10 cases and tremor-rigidity-mixed-type in 11 cases.According to Hoehn&Yahr classification,there were 6 cases in levelⅢand 15 cases in levelⅣ.The targets of all the patients were located in bilateral STN using MRI pre-operatively.And the targets were adjusted using MER intra-operatively.After it was comfirmed deep brain stimulation was performed.And the patients were followed-up for more than 1 year to observe the effect.Results All the patients were accurately located in bilateral STN using MRI preoperatively.The targets of 10 cases were adjusted during the operation using MER.The adjustable target was in the contralateral STN.All the operations were smoothly performed.The average operation time was 3.51±1.23 h.And 42 stimulation electrodes were implanted.The post-operative movement improvement rate was 41.25~87.64%(mean 60.24±4.35%).There was significant difference in LDE between pre-operation and post-operation(P<0.05).And on state(drug-on and drug-off)post-operative UPDRS-Ⅲscore was significantly lower than pre-operative score(P<0.05).Conclusion Pre-operative MRI anatomical location combined with intra-operative MER functional location can improve the efficancy of deep brain stimulation,which is a type of safe and effective surgical treatment method for medium-late stage PD.