| Research background:Parkinson’s disease (PD). also known as Paralysis Agitans. was described by Parkinson at1817firstly, manifests with resting tremor, bradykinesia. rigidity and gait abnormalities. PD patients often get disease after the60years old. so it is a common neurodegenerative disease. Its rate is about1000/10million, and increased with age. Etiology of idiopathic Parkinson’s disease remains unknown. The pathogenesis of PD is very complex, may be associated with aging, environmental factors, genetic factors.The Parkinson’s disease often come up at60years old, sometime occur at20years old. The symptoms often occur from one side limb to ipsilateral lower extremity, and then to the contralateral upper limb and lower limb, showing "N" type development. There are a few cases from the beginning of one side of the lower limbs. Starting from both sides of the lower extremities is very rare. Because Parkinson’s disease affects patients’ moving ability, with the slow progression of the disease, the vast majority of patients with Parkinson’s disease will eventually be detained in the home, bed, added a heavy burden for the family and the society. Parkinson’s disease patients’ caregivers also exist the decline in the quality of life of the situation, this point in the treatment of Parkinson’s disease is often overlooked. In addition to Parkinson’s disease also can bring the huge economic burden to society, a recent American study showed that patients with Parkinson’s disease, the annual health care costs and direct drug costs are higher than other diseases. Therefore, active treatment and effective control of Parkinson’s disease are of great significance for patients and their families and society.At present the treatment of Parkinson’s disease is mainly with the drugs, of which compound levodopa is one of the commonly used drugs, and is good at early clinical effect. Levodopa can effectively reduce the motor symptoms of Parkinson disease patients. Bur3-5years after the drug use. some limitations will come out. It will give patients with motor complications, manifested as "wearing-off phenomenon","switch" phenomenon, dyskinesia. Surgery by stereotactic operation for Parkinson’s disease began in the40’s of last century. Spiegel and Wycis in the United States firstly applied stereotactic concept to clinical treatment of movement disorders and established the function department of Neurosurgery stereotactic position. In1955Hassler and Riechert founded the ventrolateral thalamotomy (thalamotomy). It has obvious effect on Parkinson’s disease tremor and stiffness, and rapidly developed in the world. Academician Wang Zhongcheng introduced the new method of stereotactic operation in domestic in the nineteen sixties, and rapidly developed in many big cities’ domestic hospitals. Because the target point positioning is not accurate enough, lesion size is difficult to control and leaded to postoperative complications. This limited the further development of stereotactic operation. The coming of CT and MRI was on the development of function in the Department of Neurosurgery of the enormous role. CT and MRI have provided technical supports for the stereotactic operation for Parkinson’s disease. Stereotactic operation in Department of Neurosurgery of microelectrode guided nerve nucleus lesioning has become an effective method for the treatment of Parkinson’s disease. Anatomical location is the premise of the operation, which is the basis of all the functions of the Department of Neurosurgery operation. Because of the location and relative distance constant of anterior (AC) and posterior (PC), it is particularly important to identify the AC-PC commissure by preoperative imaging method. However, because AC, PC are deep in the brain, they are difficult to measure. So the extracranial anatomic landmarks are the basis to design the CT or MRI baseline, and to head base ring and parallel to AC-PC plane. However, previous studies obtained through imaging cadaveric dissection or crude, there are some errors and limitations. Due to different geographical, ethnic, national differences and differences in research methods, research datas are greatly different. Our study intends to analysis large samples of normal Chinese adult in Southern China area based on MRI data. We will get the angle of canthomeatal line and the AC-PC plane, delineate accurately the AC-PC plane on the body surface to assistant Parkinson quickly locate function department of Neurosurgery before operation.Research objective:This study is based on a large sample of normal Chinese adult in Southern China area of skull high resolution3.0T ultra high field magnetic resonance scanner data. We aim to get the angle of canthomeatal line and the AC-PC plane, delineate accurately the AC-PC plane on the body surface to assistant Parkinson quickly locate function department of Neurosurgery before operation. And we will get the relationship between the changes of the datas change with gender, age, and to give the clinical validation.Materials and methods:1Research object:120adult healthy volunteers were recruited from Guangdong, Guangxi. Hainan provinces, in which male and female were both60cases, age19-70years old. average age is46years old. The research object were divided into three groups according to the age:19-39years old for the young group (60cases).40-59group (47cases), age60-70years old group (13cases).2MR1scan:using high resolution3.0T ultra high field MR scanner (Achieva3.0T TX. Philips Healthcare, Netherlands).3Data measurement and analysis:(1) Determination of angle of canthomeatal line and AC-PC plane:MR1image was introduced into Mango2.6software (Research Imaging Institute. University of Texas Health Science Center. USA) and RadiAnt DICOM Viewer (Medixant company. Poznan. Poland). AC. PC were identificated. Open rearward angle was measured in the software, also with the vertical distance from the external auditory canal and middle sagittal projection point to AC-PC line.(2) Determination of the lengh of AC-PC:using the computer aided3D calibration, measure the distance from the middle of AC posterior to the edge of PC midpoint.(3) Statistical analysis:datas were statistically analyzed using SPSS20statistical software. The measurement data are expressed by mean+SD. use the independent sample t test to compare any two independent samples, using the Pearson correlation analysis to analysis the correlation of two parameters. P<0.05was considered statistically significant differences.(4) Clinical verification:clinically selecting the patients who were going to do brain stereotactic operation with a total of30cases, including male18cases, female12cases, age20～65years (mean48.6years).26cases of Parkinson’s disease,4cases of torsion spasm. The parameters above were measured by preoperative AC-PC plane projection line on the surface outline, and get the deviation comparing with the actual AC-PC plane. Results:1The average length of AC-PC line of Southern China Hans adult cerebral (LI) is23.74±0.95mm, the average length of male of24.35±0.64mm, the average length of23.14±0.95mm women, youth group is24.11±0.55mm. middle-aged group was23.60±0.87mm,22.58±1.49mm in aged group. The average angle of canthomeatal line and AC-PC line is12.03±1.11°, average male was12.17±1.06±, women on average is11.89±1.14°, youth group was12.04±1.75middle-aged group was12.13±1.79±. elderly patients was11.80±1.72°. The average length of the vertical distance from external auditory canal midpoint to the AC-PC plane is48.69±4.03mm. average male was49.57±3.10mm, the average woman is47.82±4.61mm.50.11±3.35mm youth group, middle age group was46±4.42mm,42.44±4.07mm in aged group.2The length of AC-PC line and the length of the vertical distance from external auditory canal midpoint to the AC-PC plane have significant difference (P<0.05). were men> women, but no obvious difference of angle of the canthomeatal line and AC-PC plane between male and female.3The length of AC-PC line and the length of the vertical distance from external auditory canal midpoint to the AC-PC plane have significant difference (P<0.05) in three age groups, were men> women, but no obvious difference of angle of the canthomeatal line and AC-PC plane.4There is not significant correlation between age and angle of AC-PC plane and canthomeatal line, while the distribution between joint diameter, vertical distance between d and age. There is moderate and significant correlation along with the age growth, and the two datas showed decreased slowly.5Making the canthomeatal line as the body marker line, in accordance with the previously measured data with approximate angle α=12°. d=48mm in the AC-PC plane surface outline and stereotactic installed, made30cases brain MRI scan of operation patients, found that AC and PC were located in the same layer of2mm thick. The deviation angle of AC-PC plane is1.56±0.63°.Conclusion:1High resolution3.0T ultra high field magnetic resonance scanning can well display the anatomy of the brain, provides the condition for the change of precise positioning and quantitative analysis in the study of brain microstructure.2The angle of canthomeatal line and AC-PC line were not significantly different between the sexes and youth, middle-aged, the elderly three groups, indicating that the parameter is relatively stable in brain structure, and can be used as the markers of body angle internal structure of location of brain, to provide the reference for clinical research.3In this study, the length of AC-PC and the vertical distance between gender and age were significantly different. Along with the growth of the age. the two datas are gradually reduced, indicating the human brain atrophy with growth of age.4Using the obtained datas from healthy people in Southern China area, we drawed the AC-PC plane on the surface of body as criteria for placing stereotactic. Then scanning plane can quickly get close to the actual AC-PC plane, and provided the important significance for the MRI stereotactic technique department of Neurosurgery function before operation. |
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