摘要
目的分析MRI图像对书写痉挛症患者基底神经核团显示的特点。评价MRI扫描技术的优劣和扫描序列优化组合。寻找及评价前后连合。观察丘脑V0和Vim核团毁损术对书写痉挛症的疗效。方法搜集2008年9月至2009年8月之间我院收治的12例书写痉挛症患者,其中11例MRI脑内未见异常病灶;1例为右侧苍白球生殖细胞瘤。12例患者除单纯的书写困难外,无任何其他神经、运动系统症状和体征。采用瑞典Leksell定向仪和Surgiplan立体定向计划系统(简称SPS)。将固定的头环一并行MRI扫描,经SPS系统处理后找到靶点并行丘脑V0和Vim核团后进行毁损术。结果12例患者MRI扫描均在同一层面显示AC、PC;MRI定位误差平均0.6mm、最大1.1mm以内。SE双回波(TE14/85)序列应为首选;所有患者在毁损术中症状立即消失,术后无偏瘫、无永久性的构音障碍和感觉异常。11例患者观察2～12个月无复发,1例因属首例毁损范围不足并于术后2个月复发。结论MRI立体定向丘脑核团位置精准。丘脑核团立体定向射频毁损术治疗书写痉挛症安全、有效、基本无复发。
Objective To evaluate the MRI advantages and sequences for best scan combination in the basal ganglia. To locate and measure the length between the AC and PC with the stereotactic plan system. To clinically observe the results of radiofrequency derogation to the thalamic V0 and Vim in patients with Writer＇s Cramp. Methods 12 cases with Writer＇s Cramp were collected from this hospital between September 2008 and Aug 2009, all 12 patients received MRI scans before treatment, nothing was found in the first 11 of them except for the last one in which goniolma was found in the right globus pallidus （GPi）. Demonstrating no other symptoms in the nervous and kinetic systems, the patients experienced writing incapability as the only one. The MRI data was processed in Surgiplan system and the nuclei targets, thalamic Vo and Vim, are aimed and profiled and finally derogated with radiofrequency. Results The structure of AC and PC was displayed well on a single MR image in all 12 patients. The orientation error of MRI was mean 0. 6mm, maximum 1. lmm. The best and verified MRI scan sequence was a double--echo spin echo with 14/85 ms echo time. Symptom in all patients was disappeared right away during surgery operation. There were no complications, such as hemiplegia, perpetual dysarthria and abnormal sensation, happening after operation. After follow--up for a period of 2 to 12 months, there was no recurrence in 11 out of 12 patients; only one patient, the first one in this collection, recurred 2 month after Vim. Conclusion MRI operation because of the inadequate derogation quantity in the Vo and volume scan is accurate in guiding stereotactic orientation to thalamic nuclei. Radiofrequency derogation under stereotactic orientation to thalamic nuclei Vo and Vim is safe, effective and basically without recurrence in Writer＇s Cramp.
出处
《立体定向和功能性神经外科杂志》
2009年第6期346-350,共5页
Chinese Journal of Stereotactic and Functional Neurosurgery
关键词
书写痉挛症
立体定向
射频毁损术
MRI
Writer＇s Cramp
Stereotactic orientation
Radiofrequency derogation
MRI
