肌张力障碍的深部脑刺激电极植入:直接立体定向定向GPI的快速自旋回声反转恢复序列技术。

Zentralblatt Fur Neurochirurgie Pub Date : 2008-05-01 Epub Date: 2008-04-29 DOI:10.1055/s-2007-1004583
M O Pinsker, J Volkmann, D Falk, J Herzog, K Alfke, F Steigerwald, G Deuschl, M Mehdorn
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引用次数: 32

摘要

目的:脑深部刺激内苍白球(GPi)是治疗难治性原发性肌张力障碍的有效方法。我们提出了使用快速自旋回波反演恢复(FSE-IR)序列直接术前可视化目标的技术。方法:连续23例严重肌张力障碍患者(平均年龄41岁,年龄范围9-68岁,男女比例11:12),采用FSE-IR成像结合立体定向、钆增强T1-MPRage图像直接显示内苍白球。在异丙酚和瑞芬太尼全身麻醉下进行完整的手术,包括立体定向MRI。我们使用了多通道微驱动系统(美敦力;Alpha-Omega)引入多达五个平行微电极,用于微电极记录(MER),并通过中央轨迹针对解剖学上预先确定的目标进行测试刺激。与中交点(mid-AC-PC)相关的初始标准坐标如下:外侧21 mm,前方3 mm,下方2 mm,然后根据目标区的直接可视化和术中神经生理学的进一步完善调整为个例。结果:在10例(43%)患者中,基于FSE-IR图像中GPi的直接可视化修改了基于地图集的标准坐标(7例为双侧,3例为单侧)。改良后的靶区横向为18.5 ~ 23.5 mm(平均20.76 mm),前方为1 ~ 7 mm(平均2.75 mm),下方为1 ~ 2 mm(平均1.95 mm)。我们根据MER和术中刺激的结果植入永久电极,以确定锥体束在中央轨迹上的反应阈值为67%,内侧为16%,前部为11%,外侧为4%,背部为2%。该手术在术后一年内取得了良好的临床疗效(伯克-法恩-马斯登肌张力障碍评分(BFMDRS)或多伦多西部痉挛性斜颈评分量表(TWSTRS)平均下降65.9%,范围20.9-91.4%)。安全性证明没有颅内出血或其他引起神经系统疾病的手术并发症。结论:倒置恢复序列是直接可视化GPi的良好工具。这些图像可以与立体定向MRI或CCT融合,可能有助于提高DBS电极植入GPi的解剖靶向性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Electrode implantation for deep brain stimulation in dystonia: a fast spin-echo inversion-recovery sequence technique for direct stereotactic targeting of the GPI.

Objective: Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an effective treatment for medically refractory primary dystonia. We present our technique for direct preoperative visualization of the target using a fast spin-echo inversion-recovery (FSE-IR) sequence.

Methods: Twenty-three consecutive patients (mean age 41 years, range 9-68 years, male to female ratio 11:12) with severe dystonia were operated using a combination of FSE-IR imaging for direct visualization of the globus pallidus internus with stereotactic, gadolinium-enhanced T1-MPRage images. The complete procedure, including stereotactic MRI, was performed under general anesthesia with propofol and remifentanyl. We used multichannel microdrive systems (Medtronic; Alpha-Omega) to introduce up to five parallel microelectrodes for microelectrode recordings (MER) and test stimulation with the central trajectory directed at the anatomically predefined target. The initial standard coordinates in relation to the mid-commissural point (mid-AC-PC) were as follows: lateral 21 mm, anterior 3 mm, and inferior 2 mm, which were then adapted to the individual case based on direct visualization of the target area and further refined by the intraoperative neurophysiology.

Results: In ten patients (43%) atlas-based standard coordinates were modified based on the direct visualization of the GPi in the FSE-IR images (bilaterally in seven patients, unilaterally in three). The modified targets ranged from 18.5 to 23.5 mm (mean 20.76 mm) laterally, 1-7 mm (mean 2.75 mm) anteriorly and 1-2 mm (mean 1.95 mm) inferiorly to the mid-AC-PC. We implanted the permanent electrode based on the results of MER and intraoperative stimulation performed to determine the threshold for pyramidal tract responses on the central trajectory in 67%, medially in 16%, anteriorly in 11%, laterally in 4%, dorsally in 2%. The procedure resulted in excellent clinical benefits (average reduction of the Burke-Fahn-Marsden Dystonia Rating Score (BFMDRS) or the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) were respectively 65.9%, range 20.9-91.4%) within the first year after surgery. Safety was demonstrated by the absence of intracranial bleeding or other surgical complications causing neurological morbidity.

Conclusion: Inversion recovery sequences are an excellent tool for direct visualization of the GPi. These images can be fused to stereotactic MRI or CCT and may help to improve anatomical targeting of the GPi for the implantation of DBS electrodes.

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Zentralblatt Fur Neurochirurgie
Zentralblatt Fur Neurochirurgie 医学-神经科学
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