[1]任志伟,李建宇,赵倬翎,等.基于纤维束示踪技术的丘脑Vim核可视化定位方法研究[J].临床神经外科杂志,2019,16(4):335-340.[doi:10.3969/j.issn.1672-7770.2019.04.012]
 REN Zhi-wei,LI Jian-yu,ZHAO Zhuo-ling,et al.A novel method exploration of tractography-based ventral intermediate nucleus visualized targeting[J].Journal of Clinical Neurosurgery,2019,16(4):335-340.[doi:10.3969/j.issn.1672-7770.2019.04.012]
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基于纤维束示踪技术的丘脑Vim核可视化定位方法研究()
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《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:
16
期数:
2019年第4期
页码:
335-340
栏目:
论著
出版日期:
2019-08-15

文章信息/Info

Title:
A novel method exploration of tractography-based ventral intermediate nucleus visualized targeting
作者:
任志伟李建宇赵倬翎卢洁张苗孙峥张默胡永生李骏驰郭松
100054 北京,首都医科大学宣武医院功能神经外科(任志伟,李建宇,赵倬翎,胡永生,李骏驰,郭松),影像科(卢洁,张苗,孙峥,张默)
Author(s):
REN Zhi-wei LI Jian-yu ZHAO Zhuo-ling et al.
Department of Functional Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing 100054, China
关键词:
原发性震颤立体定向手术弥散张量成像纤维束示踪丘脑腹中间核
Keywords:
essential tremor stereotactic surgery diffusion tensor image tractography ventral intermediate nucleus
分类号:
R651.1
DOI:
10.3969/j.issn.1672-7770.2019.04.012
文献标志码:
A
摘要:
【摘要】目的 探讨纤维束示踪技术定位丘脑腹中间核(Vim)的可靠性及安全性。方法对10例需行丘脑Vim核细胞刀毁损术的原发性震颤患者,术前采集60个方向的磁共振弥散张量成像(DTI)资料,应用美敦力S7神经导航进行纤维束重建及术前计划。通过对锥体束、内侧丘系及齿状红核丘脑束(DRT)进行纤维束示踪,可视化定位Vim核靶点位置。对比其与常规方法得到的Vim核靶点坐标,通过术中宏刺激判断靶点感觉及运动阈值,验证靶点坐标。比较患者手术前后的Fahn震颤评分;术后复查毁损灶位置。结果本组患者的平均年龄为64.9岁,前后联合(AC-PC)长度为(23.6±1.5)mm,第三脑室半径为(2.6±0.8)mm。常规靶点坐标,x:(14.1±0.8)mm,y:(-5.9±0.4)mm;DTI靶点坐标,x:(14.6±0.8)mm,y:(-5.7±1.0)mm。4例患者不同方法得到靶点坐标相差≥1.5 mm。全部患者先按常规靶点穿刺,其中2例患者因感觉阈值异常,与DTI靶点坐标完全一致,术中调整后效果良好。患者手术前后的Fahn震颤评分比较,平均改善率为80.1%。结论基于纤维束示踪技术的可视化靶点定位方法对于Vim核位置变异较多的情况具有可行性,可增加丘脑Vim核靶点定位的准确率。
Abstract:
Abstract: ObjectiveTo evaluate the reliability and safety of tractography-based ventral intermediate nucleus(Vim) targeting. Methods10 patients with essential tremor(ET) who underwent Vim thalamotomy were preoperatively taken 60 directions of diffusion tensor imaging (DTI), Medtronic S7 neuro-navigation was used for fiber tracking and target planning. The location of the Vim target was based on fiber tracing of the pyramidal track, medial lemniscus and dentate-rubro-thalamic tract(DRT). The coordinates of the Vim obtained by the conventional indirect targeting were compared with tractography-based targeting, and the sensory and motor threshold were judged by intraoperative macro stimulation to verify the target. The reliability and safety of the new method were confirmed by comparing the Fahn-Tolosa-Marin tremor rating scale before and after surgery, and the postoperative MRI scan of the lesion location. ResultsEssential tremor patients, with an average age of 64.9 years, AC-PC length was (23.6±1.5) mm, third ventricle radius was (2.6±0.8 mm, conventional targeting coordinates, x:14.1±0.8 mm, y:-5.9±0.4 mm, DTI targeting coordinates, x:14.6±0.8) mm, y(-5.7±1.0) mm. Four patients with the coordinate differences more than 1.5 mm between two methods, all patients were operated according to conventional targeting method firstly. Two patients’ targets were completely consistent with the DTI targeting coordinates, due to normal sensory threshold after intraoperative adjustment. The overall improvement of Fahn rating scale after surgery was 80.1%. ConclusionsIf this method can be promoted, the accuracy of Vim targeting will be improved.
更新日期/Last Update: 2019-08-01