【作者】 郝斌；

【导师】 周晓平； 胡小吾；

【作者基本信息】 第二军医大学 ， 神经外科， 2008， 博士

【摘要】 第一部分丘脑底核的核磁共振可视化三维重建目的探讨利用核磁共振成像三维重建技术对帕金森病患者及健康对照的丘脑底核进行可视化三维重建及定量研究。方法随机选择16例40岁以上健康成人及行STN-DBS治疗的6例双侧STN-DBS患者,通过MRI三维重建技术,并测量丘脑底核的体积及重建后三维体积参数。结果MRI三维重建可以清楚的显示丘脑底核的三维立体构像。经三维重建测量,40～49岁组STN体积平均138.85±7.04mm,50～59岁组118.34±13.04mm3,60岁以上组109.88±11.37 mm3,提示其体积随年龄增长有所减小;两侧丘脑底核体积比较左侧125.775±15.05 mm3,右侧118.46±16.59 mm3,提示左侧丘脑底核体积较右侧稍大;男性平均129.31±15.02 mm3,女性平均114.90±13.92 mm3,男性丘脑底核体积较女性大,在不同年龄组均有此特征。帕金森病组丘脑底核体积双侧平均82.72±9.22 mm3,左侧85.36±9.83 mm3,右侧80.08±8.78 mm3,均较正常同年龄组小。STN MRI三维重建对帕金森病患者功能核团体积评估效果良好,随着三维重建技术改进必将成为立体定向神经外科必不可少的工具。结论MRI三维重建可较好的重建STN的三维结构,以利于对其进行测量研究。MRI三维重建在立体定向神经外科临床及研究可以有十分广泛的应用。第二部分丘脑底核靶点位置与脑深部电刺激治疗帕金森病相关研究目的探讨帕金森病丘脑底核脑深部刺激术靶点定位的相关影响因素。方法回顾分析我院采用STN-DBS治疗的帕金森病患者23例,并对其中6例行MRI三维重建。术前采用姚氏线为参照安装定位头架,MRI图像定位计算靶点坐标,脑内电极临时刺激、C臂机透视,术中复查MRI核实电极位置等手段进行靶点定位和验证。利用随访资料结合术后复查MRI测量实际刺激触点坐标。结果本组MRI术前定位坐标和术后电极尖端实际位置比较,发现除左侧X坐标无显著差异,而其余各方向坐标则有显著差异。右侧X坐标值向内偏移相对明显。本组实际STN刺激位置坐标为:X=11.45±1.39 mm,Y=-1.87±1.56mm,Z=-2.01±1.9 mm显示STN中上外侧部的刺激效果更佳。对随访患者术后长期复查MRI的影像与术后即刻的MRI复查分析比较发现电极位置无移位,术后即刻复查的MRI影像资料可做为判定电极实际刺激触点的依据。结论MRI检查对DBS是安全的,STN的MRI图像直接定位准确可靠。术后即刻复查的MRI影像资料可做为判定电极实际刺激触点的依据。STN中上部的刺激效果更佳。更多还原

【Abstract】 SECTION 1 Subthalamic nucleus Visualization of three- dimensionally reconstructedObjective:Exploring three-dimensional reconstruction of magnetic resonance imaging technology to the measurements of healthy control and parameters of patients of Parkinson’s disease subthalamic nucleus of visualization the three-dimensional reconstruction and size and so on.Method:Randomly selected 16 cases of healthy adults over 40 years of age andⅠSTN-DBS Bank hospital treatment of the detailed information in the choice of Parkinson’s disease 6 cases of bilateral STN-DBS said MRI three-dimensional reconstruction.And measure the size of the subthalamic nucleus and three-dimensional parameters.Result:MRI three-dimensional reconstruction can be clear indications that the subthalamic nucleus of the three-dimensional conformation, lines smooth,sleek appearance.40-49 year-old group STN volume average is 138.85±7.04mm,50-59-year-old group is 118.34±13.04mm3,above 60 years of age group is 1109.88±11.37 mm3 suggested that growth in volume decreases with age,the volume of bilateral subthalamic nucleus comparison left is 125.775±15.05mm3,right is 118.46±16.59mm3 suggested that the left subthalamic nucleus right size larger than the male average is 129.31±15.02 mm3 female average is 114.90±13.92 mm3 subthalamic nucleus size male than female,are in different age groups this feature.The subthalamic nucleus in Parkinson’s disease group volume of bilateral mm3 average is 82.72±9.22, 85.36±9.83 mm3in left,right is 80.08±8.78 mm3,smaller than the normal age group.Although MRI three-dimensional reconstruction effective,takes a longer time to check all clinical,there are certain difficulties complete clinical application,but as technology advances it will become stereotactic neurosurgery indispensable tool.Conclusion:MRI three-dimensional reconstruction can be good redevelopment SIN. STN volume growth decreases with age,the left more than the right,men more than women,healthy people than Parkinson’s disease.Although the use of certain problems there are bright prospects for its development.SECTION 2 Correlative factors analysis of the target localizationObjective:Discussing Parkinson’s disease on the subthalamic nucleus deep brain stimulation of the target location relevant factors.Method:Recalling my hospital STN-DBS in the treatment of Parkinson’s disease have detailed information on the 23 cases, six of them routine MRI and three-dimensionally reconstructed reconstruction,line of Yao preoperative used to be location for the installation of the light planes before surgey,MRI image positioning of target coordinates,microelectrode recording in the surgey,temporary brain stimulation electrodes,the C-arm machine perspective,in the review of MRI to verify the actual position of electrode means target location and verification.Results:MRI can cause abnormal stimulator turned on or off,but the frequency and pulse width parameters were not affected,inspection before stimulator voltage set to 0 avoidable accidents.DBS MRI examination is not taboo.After review of the long-term follow-up of patients with MRI images and immediately after the review of the MRI found no shift electrode position,immediately after the review of the MRI images can be used as a stimulus determine the actual electrode contacts basis.This group preoperative MRI positioning coordinates and the electrode tip actual location,the results showed that in addition to X coordinates left no significant difference,and the remaining coordinates direction there are noticeable differences.Opened right next to the most obvious direction of inward migration.This group the best position to stimulate the STN:X=11.45±1.39 mm,Y=-1.87±1.56 mm, Z=-2.01±1.9mm STN display on the outside of the Department of stimulating a better effect.Conclusions:MRI examination is safe to DBS,the STN’s MRI images directly positioning accurate and reliable.MRI immediately after the review of the image data can be used as a stimulus determine the actual electrode contact basis.In the upper part of the STN to stimulate a better effect.更多还原