Exploration With MRI Of Correlation Between Conditions Of Stereotactic Radiofrequency Lesioning Of Nucleus Accumbens And The Therapeutic Effect

BackgroundOpioid drug addiction is a chronicity recurrent attacks cerebropathia.Opioid drug acting in cerebrum leads to psychological and behavioral error state which refer to a series of biochemical process and cognition,personality,mood and so on.The main compose of reward or strengthen system is mesencephal-cortex-fringe dihydroxyphenyl ethylamine system.Ennoblement and tolerance , formation and maintenance , negativity mood after drug withdrawal have a close relation to this system.Nucleus accumbens sept is the transfer floodgate of drug augmentation to behavioral.research in neuroanatomy shows that nearly all mat which cause to addiction can raise dopamine in NAc.VTA-NAc-PFC(prefrontal lobe cortex) is the neuroanatomy foundation of rewarding effect and physical dependence.Nowadays,the main treatment of opioid drug addiction are medication psychotherapy,psychotherapy,prophylactic education and so on.Medication only relief physical dependence temporarily,therapeutic efficacy of other treatments is not good.Relaps rate of nonsurgery is 80%-85%(1 month),95%(half a year),97%(more than half a year).Psychological dependence is the key point.With the development of stereotactic neurosurgery,intervention of deep brain nuclear may become effective method of the relief of drug psychological dependence.research shows that to destroy NAc can relieve craving,euphoria and relaps.NAc has become the main target of surgery.This article use high field MR image to analyze stereotaxis NAc radio frequency surgery in the relation between accuracy of target,dynamism of destroy and effect,complication.ObjectiveTo explore the correlation of the therapeutic effect and complications with the quality of target location and volume of the lesion in stereotactic radiofrequency surgery of nucleus accumbens for drug abstinence.MethodsThe clinical materials of 55 volunteers of drug addict who underwent stereotactic radiofrequency lesioning of the nucleus accumbens were retrospectively studied. Postoperative 3.0T MRI measured the average size of the lesion focus and average coordinate data of the lesion center. The relationship of the location and size of the lesion focus with the efficacy and complications was investigated according to statistics.ResultsNon-relaps with no complications were achieved in 27 cases, non-relaps with complication s in 14, relaps in 10, and relaps with complications in 4. Total effective rate was 74.5%, relapse rate was 25.5%.The coordinate of the best effective target within nucleus accumbens was as follows: x was (6.2±0.4) mm, y (22.7±1.2) mm, z (-5.3±1.5) mm. complications were as follows: anterograde amnesia and intention formation dysfunction in 10 cases, loss of sexual desire in 1, emotional disorder in 2,insensitivity of olfaction in 3 and temporary mutism in 2.ConclusionStereotactic radiofrequency surgery of nucleus accumbens can effectively treat drug abstinence.Accurate and measurable lesion to the ventromedial part of nucleus accumbens is the basic principle.The efficacy and complications are associated withthe location and volume of the lesion focus.Deviate target or too small lesion focus will be of no effect. Both a lesion deviating from the effective target point and too big lesion focus will induce occurrence of complications。...