摘要
目的 :帕金森病病人丘脑VIM核射频毁损术后早期MR检查 ,观察毁损灶在MR上表现与VIM核射频毁损的预后关系。方法 :92例帕金森病病人共行 97次VIM核射频毁损术 ,术后早期 (1～ 7天 )常规行磁共振T1加权和T2 加权矢状位、轴位和冠状位扫描。轴位测量毁损靶点的横径。冠状位观察靶点毁损的最低点相对与第三脑室顶的深度与同一层第三脑室高度比值 (深度比值 ) ,及靶点毁损最外缘距中线距离 (最外缘 ) ,并观察毁损灶与内囊关系 ;矢状位或轴位观察靶点毁损最后缘距AC -PC中点的距离 (最后缘 )。通过以上观察与VIM核毁损术后效果进行比较。其中有 9例病人 ,术后 3月至 18月螺旋CT复查 ,通过基底节 2mm一层的扫描 ,可发现毁损灶 ,测量毁损灶大小。结果 :92例帕金森病病人共行 97次VIM核射频毁损 ,术后震颤消失率 10 0 % ,肌强直改善率10 0 % ,运动迟缓和运动不能无改善。 97次MR检查创道及丘脑毁损区均未见出血 ,创道仅有轻微水肿 ,仅发现 1例穿刺部位皮层小血肿 ,并导致癫痫大发作。 92例病人随访 1～ 2 6月 (仅有 10例随访少于 6月 ) ,73例 (75 % )病人无复发 :横径平均为 6 .6± 1.86mm ;最外缘平均为 19.2 8± 2 .14mm ;最后缘平均为 9.6 3± 2 .14mm ;深度比值平均为 0 .84± 0 .0 9。 14例 (15 % )
Objectives:Study the correlation between early postoperative appearance of radiofrequency lesions on magnetic resonance imaging and results of stereotaxic ventralis intermedius thalamotomies on Parkinson's disease.Methods:In 92 patients with Parkinson's disesse,97 stereotaxic Vim thalamotomies were performed using CT directed-guided.All patients had MR imaging followed-up 1 to 7 days postopertaively to determine the early appearance of their lesions.MRI studies included routine sagittal,axial and coronal images using T 1-weighted imaging and T 2-weighted imaging.On axial images,transverse diameter of the lesions were measured;On coronal images,the depth ratio (the value of the distance from the lowest point of the lesion to the apex of third ventricle than the high of third ventricle) and the most exterior edge (the distance from the most exterior point of the lesions to midline) were measured;On axial and sagittal images, the most posterior edge(the distance from the most posterior point of the lesions to the midpoint of AC-PC line) was measured.In 9 patients of all patients,span CT were obtained postoperative follow-up 3 to 18 months.Results:In 92 patients.97 operations resulted in complete abolition of tremor and improve of rigidity.MR showed no bleeding of the probing tract and the lesions of thalamus,only one small bleeding at the probing subcortex resulted in epilepsy. 92 patients followed up 1 to 26 months postoperatively, 73 patients(75%) had no recurrence:the mean transverse diameter was 6.6±1.86mm;the mean most exterior edge was 19.28±2.14mm;the mean most posteroir edge was 9.63±2.14mm;the mean depth ratio was 0.84±0.09.14 patients (15%) had all recurrence of tremor:mean transverse diameter was 4.55±1.58mm;the mean most exterior edge was 7.28±2.07mm;the mean most posterior edge was 8.82±3.26mm;the mean depth ratio 0.73±0.15. 6 patients (6%) had recurtence of hand tremor: the mean transcerse diameter was 4.24±0.91mm;the mean most exterior edge was 19.0±0.9mm;the mean most posterior edge was 10.90±2.59mm;the mean depth ratio was 0.82±0.11. 4 patients (4%) had recurrence of foot tremor:the mean transverse diameter was 6.29±1.02mm;the mean most exterior edge was 18.21±1.37mm;the mean most posterior edge was 9.64±2.14mm;the mean depth ratio was 0.80±0.16. Through t test,between the patients of no recurrence and the patiens of all recurrence of tremor,there are significant difference( P <0.01)in transverse diameter,the most exterior edge and the depth ratio, no difference in the most posterior edge; between the patients of no recurrence and the patients of recurrence of hand tremor,there are singificant difference in transverse diameter,no difference in the rest;between the patients of no recurrence and them of recurrence of foot tremor,there are no significant in all aspect,but MR found that there was the distance from the most exterior edge to internal capsule.In 9 patients the mean diamerer of the lesions showed by early postoperative MR was 5.77 ±2.15mm,the mean diamerer showed by span CT followed-up was 1.74±0.68mm.10 patients had contralateral slight weakness,MR showed the lesions encroached on the internal capsule.Conclusions:Early MR followed-up Vim thalamotonies may find whether the lesions resulted in severe complications such as bleeding,encroahing on the internal capsule and so on and predict the results of Vim thalamotomies by inspecting size and depth of the lesions and the relation between the lesions and the internal capsule on MR images.
出处
《立体定向和功能性神经外科杂志》
2001年第2期75-79,共5页
Chinese Journal of Stereotactic and Functional Neurosurgery
