摘要
目的探讨弥散张量成像(DTI)追踪齿状-红核-丘脑束在脑深部电刺激(DBS)治疗帕金森病震颤症状的应用价值。方法回顾性分析7例诊断为伴震颤症状的原发性帕金森病的病例资料,结合手术前后MRI和CT等影像数据,通过软件追踪齿状-红核-丘脑束。2例病人为单侧震颤症状仅植入一侧电极,5例病人双侧震颤植入双侧电极,每侧电极4个触点,电极触点共48个。排除刺激引起副作用的触点6个,实际有效电极触点42个。计算有效电极触点到齿状-红核-丘脑束的最近空间距离,分析震颤改善程度与距离的相关性。结果在同一刺激参数程控下,电极触点到齿状-红核-丘脑束的最近空间距离,震颤改善率>50%组为(1.74±1.13)mm,震颤改善率≤50%组为(2.76±1.22)mm;两组间差异具有统计学意义(t=2.78,P<0.05)。电极触点到齿状-红核-丘脑束的最近空间距离与震颤改善程度具有相关性(R=0.55,P<0.05)。结论 DBS作用于齿状-红核-丘脑束,与震颤改善相关,未来需进一步严密设计临床试验来验证其应用价值,以实现精确靶点定位和个体化治疗。
Objective To evaluate the clinical value of the dentatorubrothalamic tract tractography by diffusion tensor imaging（DTI） in deep brain stimulation（ DBS） for the treatment of tremor symptoms of Parkinson Disease. Methods The clinical data of 7 patients diagnosed as having idiopathic Parkinson Disease with tremor symptoms were analyzed retrospectively. The dentatorubrothalamic tract was traced by software with preoperative and postoperative MRI, CT image data. The unilateral electrode was implanted into 2 patients with unilateral tremor symptom, bilateral electrodes in 5 patients with bilateral tremor symptoms. There were 4 contacts in each side of DBS electrode and totally 48 contacts. The 42 contacts were effective, 6 contacts were excluded due to complications. The nearest space distance of 42 effective contacts to dentatorubrothalamic tract was calculated. The correlation between the improvement of tremor and the distance was analyzed. Results Under the same stimulus parameters, the nearest space distance of contact to the dentatorubrothalamic tract was 1.74±1.13 mm in 50% improvement of tremor group and 2.76±1.22 mm in ≤50% group,the difference between the two groups was statistically significant（t = 2.78, P〈0.05）. The nearest space distance of each electrode contact to the dentatorubrothalamic tract was related to the improvement of tremor（R = 0.55, P〈0.05）. Conclusions DBS of the dentatorubrothalamic tract is in coincidence with the improvement of tremor. In the future, we need further rigorous clinical trials to verify its application value in order to achieve precise target location and individualized treatment.
作者
陈宇昆
王学廉
Chen Yukun;Wang Xuelian(Department of Neurosurgery, Tangdu Hospital of the Fourth Military Medical University, Xi＇an, Shaanxi 710038, China)
出处
《中国微侵袭神经外科杂志》
CAS
2018年第5期193-196,共4页
Chinese Journal of Minimally Invasive Neurosurgery
关键词
帕金森病
弥散张量成像
齿状-红核-丘脑束
脑深部电刺激
震颤
Parkinson Disease
diffusion tensor imaging
dentatorubrothalamic tract
deep brain stimulation
tremor
