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随着医疗技术的不断发展,脑立体定向手术以安全、微创等优点近些年在临床应用广泛,是治疗难治性癫痫的有效方法。颞叶癫痫是难治性癫痫的常见类型,其传统外科手术治疗如颞前叶切除术及选择性海马、杏仁核切除术会大范围切除病灶,对颞叶皮质造成较大损伤从而导致病人可能出现语言、记忆功能障碍以及视野缺损等并发症[1-2],而脑立体定向技术的应用可以减小手术创伤面积,提高癫痫病灶损毁的精细度,从而保护病人的智力及情感等脑高级功能[3-4]。在痫性放电起于海马沟区域的颞叶内侧难治性癫痫外科手术治疗中, 脑立体定向电极植入术以及立体定向射频热凝阻滞疗法等的穿刺轨迹及靶点定位均基于海马沟立体定位数据集的获取。大脑海马沟位于海马本体(Ammon′s horn, 阿蒙角)、齿状回及下托之间,在MRI图像上对海马沟的识别有助于区分海马内部信号一致的灰质结构。本研究将基于MRI观察海马沟的形态学,同时在冠状面图像上测量海马沟的三维坐标值,构建出海马沟的立体定位数据集并进行回归分析,了解海马沟在横断面、冠状面及矢状面上坐标值间的相关性,揭示海马沟的形态学规律,为海马区域病灶的立体定向治疗, 如立体定向海马杏仁核射频损毁术、脑深部电刺激等的精准定位提供数字化解剖学参考。
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在30名正常成年人脑T1 Bravo MRI图像中,海马沟在冠状面上共出现344层,其中左侧海马沟所在层面共164层(男性85层,女性79层),右侧180层(男性91层,女性89层)。海马沟90%出现在冠状面原点层面的后方,共出现315层,其中左侧153层(男性78层,女性75层),右侧162层(男性81层,女性81层)。各层面上海马沟X、Z坐标值的均差及标准差见表 1~2。
Y/mm x±s z±sd 右侧 左侧 右侧 左侧 -6 -30.600±4.101 36.300±0.000 -39.150±7.990 -35.400±0.000 -3 -30.500±3.057 34.067±1.849 -38.300±6.773 -37.283±8.804 0 -32.346±3.409 33.862±2.943 -36.654±6.860 -36.523±6.986 3 -33.093±3.217 34.513±3.176 -34.771±5.493 -33.780±6.236 6 -34.613±2.809 35.287±3.010 -33.140±6.069 -32.160±6.884 9 -35.093±3.136 35.880±3.127 -31.173±5.390 -31.100±6.551 12 -34.838±3.887 35.093±3.098 -29.285±5.351 -29.764±6.576 15 -35.000±4.725 34.967±3.199 -28.163±5.403 -26.267±9.373 18 -36.300±3.466 — -30.400±5.546 — 合计 -33.807±3.632 34.908±2.971 -33.076±6.522 -32.515±7.346 表 1 男性冠状面上海马沟外侧缘取样点的三维坐标值(n=15)
Y/mm x±s z±sd 右侧 左侧 右侧 左侧 -6 -38.350±5.445 — -41.250±2.051 — -3 -36.400±7.619 36.450±4.288 -42.483±8.011 -36.400±3.896 0 -36.140±7.168 34.625±6.449 -40.510±8.600 -38.663±9.289 3 -36.492±6.355 34.125±5.356 -40.346±8.598 -38.208±7.925 6 -36.813±5.221 35.300±6.017 -39.907±8.872 -37.871±7.970 9 -36.933±5.256 35.647±5.184 -37.193±9.469 -37.033±8.904 12 -36.079±5.457 35.971±5.390 -36.329±8.423 -36.229±8.508 15 -35.573±4.756 35.210±4.917 -35.909±7.394 -34.330±7.962 18 -39.000±2.921 34.950±0.354 -33.667±12.712 -30.650±6.859 合计 -36.522±5.548 35.276±5.235 -38.518±8.586 -36.847±8.042 表 2 女性冠状面上海马沟外侧缘取样点的三维坐标值(n=15)
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(1) 横断面上Y值对X值的回归分析,右侧:Y=-0.380-0.198X(r=0.161,P>0.05),左侧:Y=2.982+0.106X(r=0.083, P>0.05)。(2)冠状面上Z值对X值的回归分析,右侧:Z=-46.379-0.302X(r=0.182, P < 0.05), 左侧:Z=-49.512+0.425X(r=0.224, P < 0.05)。(3)矢状面上Z值对Y值的回归分析,右侧:Z=-38.501+0.416Y(r=0.308, P < 0.01),左侧:Z=-36.793+0.326Y(r=0.221, P < 0.01)。(4)海马沟在各个层面的回归方程散点图见图 2。
大脑海马沟立体定位数据集的构建及投影回归分析
Construction of stereotactic localization data set and projection regression analysis of hippocampal sulcus
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摘要:
目的构建大脑海马沟基于连合间径(AC-PC)定位体系中的立体定位数据集及其平面投影回归方程。 方法将30名健康成年人颅脑横断层MRI数据经格式转化导入Photoshop CS软件包,经过严格的图像配准,建立以AC-PC中点为原点的三维立体坐标系,获取海马沟在脑MRI冠状面图像上的三维立体坐标值,以海马沟的最外侧点为起始点,记录该点坐标的X、Z值,其在软件的信息面板中直接显示,Y值为该图像所在层面与AC-PC层面间隔的层数乘以层间距,所有取样点坐标值构成大脑海马沟在三维坐标系中的立体定位数据集。利用SPSS25.0对所获取的取样点数据进行统计处理,求解其投影回归方程。 结果成功构建大脑海马沟在在三维坐标系中的立体定位数据集及其在横断、矢状、冠状面上的投影回归方程。冠状面上Z值对X值回归方程,右侧: Z=-46.379-0.302X(P < 0.05), 左侧: Z=-49.512+0.425X(P < 0.05);横断面上Y值对X值回归方程,右侧: Y=-0.380-0.198X(P>0.05), 左侧: Y=2.982+0.106X(P>0.05);矢状面上Z值对Y值回归方程,右侧Z=-38.501+0.416Y(P < 0.01), 左侧: Z=-36.793+0.326Y(P < 0.01)。 结论大脑海马沟横断、冠状及矢状面的三维坐标值间的相关关系较不密切。构建的海马沟立体定位数据集可为海马区域病灶定位及该区域脑立体定向手术的靶点确定、手术路径规划提供精确的影像解剖学数据。 Abstract:ObjectiveTo construct the stereotatic localization data set and its plane projection regression equation of the hippocampal sulcus based on the AC-PC localization system. MethodsThe transverse tomography data of 30 healthy adults were imported into Photoshop CS software package by format transformation.After strict image registration, a three-dimensional sitting system with AC-PC midpoint as the origin was established to obtain the three-dimensional coordinate values of hippocampal sulcus in the coronal plane images of brain.Taking the outermost point of the hippocampal sulcus as the starting point, record the X-value and Z-value, which were directly displayed in the information panel of the software, and the Y-value was the product of the number of layers between the image layer and AC-PC plane and interlayer spacing.The stereotactic data set of the hippocampal sulcus in a three-dimensional coordinate system were constituted by all the coordinate values of sample points.The SPSS25.0 software was used to calculate the obtained sampling point data, and solve the projection regression equation. ResultsThe stereotaxic dataset of the hippocampal sulcus in the three-dimensional coordinate system and its projection regression equation on the transverse, sagittal and coronal planes were successfully constructed.On the right side of the regression equation of Z-value to X-value on the coronal plane: Z=-46.379-0.302X(P < 0.05), on the left side: Z=-49.512+0.425X(P < 0.05).On the right side of the regression equation of Y-value to X-value on the transverse plane: Y=-0.380-0.198X(P>0.05), on the left side: Y=2.982+0.106X(P>0.05).On the right side of the regression equation of Z-value to Y-value on the sagittal plane: Z=-38.501+0.416Y(P < 0.01), on the left side: Z=-36.793+0.326Y(P < 0.01). ConclusionsThe correlation among the three-dimensional coordinate values of the transverse, coronal and sagittal plane of the hippocampal sulcus of the brain is not close.The stereotactic localization data set of the hippocampal sulcus provides accurate image anatomical data for the localization of lesions, the target determination and surgical path planning of stereotactic surgery in the hippocampal region. -
Key words:
- hippocampal sulcus /
- stereotatic localization /
- regression analysis
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表 1 男性冠状面上海马沟外侧缘取样点的三维坐标值(n=15)
Y/mm x±s z±sd 右侧 左侧 右侧 左侧 -6 -30.600±4.101 36.300±0.000 -39.150±7.990 -35.400±0.000 -3 -30.500±3.057 34.067±1.849 -38.300±6.773 -37.283±8.804 0 -32.346±3.409 33.862±2.943 -36.654±6.860 -36.523±6.986 3 -33.093±3.217 34.513±3.176 -34.771±5.493 -33.780±6.236 6 -34.613±2.809 35.287±3.010 -33.140±6.069 -32.160±6.884 9 -35.093±3.136 35.880±3.127 -31.173±5.390 -31.100±6.551 12 -34.838±3.887 35.093±3.098 -29.285±5.351 -29.764±6.576 15 -35.000±4.725 34.967±3.199 -28.163±5.403 -26.267±9.373 18 -36.300±3.466 — -30.400±5.546 — 合计 -33.807±3.632 34.908±2.971 -33.076±6.522 -32.515±7.346 表 2 女性冠状面上海马沟外侧缘取样点的三维坐标值(n=15)
Y/mm x±s z±sd 右侧 左侧 右侧 左侧 -6 -38.350±5.445 — -41.250±2.051 — -3 -36.400±7.619 36.450±4.288 -42.483±8.011 -36.400±3.896 0 -36.140±7.168 34.625±6.449 -40.510±8.600 -38.663±9.289 3 -36.492±6.355 34.125±5.356 -40.346±8.598 -38.208±7.925 6 -36.813±5.221 35.300±6.017 -39.907±8.872 -37.871±7.970 9 -36.933±5.256 35.647±5.184 -37.193±9.469 -37.033±8.904 12 -36.079±5.457 35.971±5.390 -36.329±8.423 -36.229±8.508 15 -35.573±4.756 35.210±4.917 -35.909±7.394 -34.330±7.962 18 -39.000±2.921 34.950±0.354 -33.667±12.712 -30.650±6.859 合计 -36.522±5.548 35.276±5.235 -38.518±8.586 -36.847±8.042 -
[1] 杨子茵, 高安亮, 李佳宇, 等. 前颞叶切除术与颞下入路选择性海马杏仁核切除术治疗颞叶内侧癫痫疗效对比[J]. 西部医学, 2022, 34(4): 566. doi: 10.3969/j.issn.1672-3511.2022.04.019 [2] 李亚飞, 尹绍雅. 前颞叶切除术与选择性杏仁核海马切除术治疗颞叶癫痫的疗效对比[J]. 中国实用神经疾病杂志, 2020, 23(12): 1036. [3] 徐成伟, 周文静, 柏建军, 等. 立体定向脑电图引导射频热凝在难治性颞叶癫痫中的应用[J]. 中华医学杂志, 2018, 98(13): 1008. doi: 10.3760/cma.j.issn.0376-2491.2018.13.011 [4] MALIKOVA H, KRAMSKA L, VOJTECH Z, et al. Different surgical approaches for mesial temporal epilepsy: resection extent, seizure, and neuropsychological outcomes[J]. Stereotact Funct Neurosurg, 2014, 92(6): 372. doi: 10.1159/000366003 [5] KARAS PJ, GIRIDHARAN N, TREIBER JM, et al. Accuracy and workflow improvements for responsive neurostimulation hippocampal depth electrode placement using robotic stereotaxy[J]. Front Neurol, 2020, 11: 590825. doi: 10.3389/fneur.2020.590825 [6] QUIGG M, HARDEN C. Minimally invasive techniques for epilepsy surgery: stereotactic radiosurgery and other technologies[J]. J Neurosurg, 2014, 121 Suppl: 232. [7] KIER EL, KIM JH, FULBRIGHT RK, et al. Embryology of the human fetal hippocampus: MR imaging, anatomy, and histology[J]. AJNR Am J Neuroradiol, 1997, 18(3): 525. [8] ALLEOBONE J, KANAAN RA, MALLER JJ, et al. Enlarged hippocampal fissure in psychosis of epilepsy[J]. Epilepsy Behav, 2020, 111: 107290. doi: 10.1016/j.yebeh.2020.107290 [9] BAJIC D, CANTO MOREIRA N, WIKSTROM J, et al. Asymmetric development of the hippocampal region is common: a fetal MR imaging study[J]. AJNR Am J Neuroradiol, 2012, 33(3): 513. doi: 10.3174/ajnr.A2814 [10] ZAMMIT AR, EZZATI A, ZIMMERMAN ME, et al. Roles of hippocampal subfields in verbal and visual episodic memory[J]. Behav Brain Res, 2017, 317: 157. doi: 10.1016/j.bbr.2016.09.038 [11] BRONEN RA, CHEUNG G. MRI of the normal hippocampus[J]. Magn Reson Imaging, 1991, 9(4): 497. doi: 10.1016/0730-725X(91)90035-K [12] LI Y, YAN J, ZHU X, et al. Increased hippocampal fissure width is a sensitive indicator of rat hippocampal atrophy[J]. Brain Res Bull, 2018, 137: 91. [13] DUAN Y, LIN Y, ROSEN D, et al. Identifying morphological patterns of hippocampal atrophy in patients with mesial temporal lobe epilepsy and Alzheimer disease[J]. Front Neurol, 2020, 11: 21.