| Backgrounds and ObjectMoringlane recommended that the perpetual nucleus lesions temperature should be controlled between 70℃ and 80℃ in the plain area. However, it has not been reported whether the low pressure, low oxygen and low boiling point could affect nucleus lesions. We want to testfy that above factors may have the effect on nucleus lesions in Tibetan plateau and further to affirm the ideal lesion temperature and lesion duration. In addition, during the period of lesion, the most serious complication is internal capsule damnification. Grass suggested that one of major factors leading to internal capsule damnification was variability of internal capsule corridor. To find out the internal capsule corridor variable factor, we studied the relationship between the variation of skull shape and oblique angle of internal capsule rear limb and testified if the variation of skull shape has the effect on the oblique angle of internal capsule rear limb. If we can affirm that there is linear relation between the variation of skull shape and oblique angle of internal capsule rear limb, it will be helpful to increase the orientation precision of nucleus lesion and provide objective bases to treat plateau motility diseases such as Parkinson's disease.MethodsIn Tibetan plateau, we studied the lesion regions after using intro - body and extro - body radiofrequency thermal coagulation by selecting fresh egg -white,pig brains and New Zealand giant white rabbits respectively. The specimenwas coagulated under the pre - selected temperatures(45,60,65,70,75,80X.) and the time lapse(20,40,60,80s). The lesion was measured by standard stainless rules under the magnifying glass. The animal brain tissue was arterial infused by 5% formalin,the specimen was enbeded by paraffin wax, cutted into slices and dyed by HE method. The slices was observed under the microscope and measured by standard rules, the histro - morphological changes was observed.1000 Han and Tibetan CT scans were selected randomly within 9000 normal CT scans. According to length and width, the index of width/length ratio (width/ length 100) was caculated. The oblique angle of internal capsule was measured by bisecting the angle between the brain mid - line and internal capsule rear limb. The angle between the bisector and the brain mid - line was defined the oblique angle of internal capsule. In trigonometry, tgct = X/Y(X is defined as the horizonal shift distance between the target point and internal capusle ,Y is defined as actual front or back shift distance parallel to mid - line. ) The data are analysed using SPSS 10.0, P<0.05 is setted as statistic significant.11 clinic patients underwent the operationts. All the patients live in Tibetan plateau (2200 -3658 meters above the sea level, mean 3366.4 meters). 8 cases underwent Vim and 3 cases underwent PVP. All the patients underwent single targeit lesion, the lesion temperatureand time lapse were setted 70^ ^Os. The patients were scored by UPDRS. The improvement rate was caculated by the formula; improvement rate = ( preoperative UPDRS - postoperative UPDRS)/ preoperative UPDRS x 100% .ResultsIn the extro - body test, the tissue around monopolar tip and between the bipolar formed olivary coagulated blots when the temperature increased gradually , at the same temperature, the diameter and length of blot increased gradually along with the increace of the time lapse(20 -60s). But there was no significant different between 60s and 80s set. During the same period, there was significant different between sets except between the 75X. and 80X, sets. Therewas a little bit conglutination at 10X, ,60s and partial tissue charcoal along with conglutination. In the intro -body test, the lesion presented the shape of ovum postopration 4h - 14d, the mean diameter was 4. 682 ±0. 04mm,mean length 3.849 0.04mm. Iiquefacient necrosis happened in the central area, under optics microscope, classic multipolar shape disappeared and appeared round shape instead. The nucleus decentred, the Nissle body broke into dust - like granule. The lesion area is the largest the seventh day after the operation, the lesion decreased 14 days after operation because of self - repair.The data is processed by SPSS software: There is significant different between male and female in the shape of skull ( T test P < 0.05 ). There is no significant different between Tibet and Han ethnic in the width/length ratio and oblique angle (T test P > 0. 05). There is significant different between long, quadrate and round skull shape in the width/length ratio and oblique angle ( P < 0. 01). The oblique angle of internal capsule and its tangent value is direct proportion to the width/length ratio by linear regression analisis(r =0.327, P <0. 01) ,that is,the larger the width/length ratio is,the larger the oblique angle of internal capsule.In 11 cases, the contralateral tremor frequency decreased obviously and dyskinesia alleviated when high frequency stimulation was done, which indicated the precise orientation. After the perpetual lesion, contralateral tremor disappeared and dyskinesia alleviated obviously. After 2-4 monthes follow - up, all patients' symptoms improved. The medication decreased by 45% , the UPDRS indicated that the " open" duration improved by 73% and the " close" duration improved by 54%. Operative complications: 1 case presented weakness, 15 days after the operation, the patients CT scan show edema around lesion,but after the hormone, dehydration and vassle enlargement treatment, the symptom improved. There is no death, obvious hemiplegia and perpetual vision loss.ConclusionsThe ideal lesion temperature and time lapse is 65 -70t and 60s. The statistic data testfy that variation of the width/length ratio is one factor of internalcapsule variation. In Vim lesion, the target point moves 0. 8158 ±0. 1444mm close to or apart from internal capsule when the probe electrode moves lmm front or back.
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