Hariz M I, Fodstad H
Department of Neurosurgery, University Hospital, Umeå, Sweden.
Stereotact Funct Neurosurg. 1999;72(2-4):157-69. doi: 10.1159/000029720.
Several recent publications have stated that the use of microelectrode recording (MER) during pallidotomy or deep brain stimulation (DBS) contributes to decreasing risks and side effects of surgery, and that such a technique is a prerequisite for minimizing lesion size and for accurate placement of the stereotactic lesion or the DBS electrode. To evaluate the consistency of these statements, we reviewed hundreds of papers and congress reports on MER- and non-MER-guided procedures published since 1992. This review showed that MER groups published more often than non-MER groups. While side effects of surgery were not uncommon in both groups, the rate of severe complications, such as hematoma, and mortality appeared to be higher when microelectrodes were used, both in ablative surgery and in DBS procedures. Besides, the nonaccurate placement of lesions or DBS electrodes, as assessed on published MRI figures, was not uncommon in MER publications. Lesion volume was, when reported, not different in both techniques. The electrical parameters of stimulation of implanted electrodes in the thalamic ventral intermediate (Vim) nucleus for treatment of tremor were higher in MER-guided surgery. The available literature suggests that MER techniques may increase the risks of surgery without enhancing its accuracy, compared to MRI-based macrostimulation techniques. To date, there is no randomized trial by one and the same group on the use of micro- versus macroelectrodes in surgery for movement disorders. A prerequisite for such a trial in the future must imply that the investigators have an equal nonprejudiced attitude towards, and equal confidence and experience in, either technique. Since such a prerequisite does not exist so far in the functional stereotactic community, a critical and comparative study of the available literature remains the only way to evaluate the pros and cons of either technique, in terms of targeting accuracy and surgical complications.
最近的几篇出版物指出，在苍白球切开术或深部脑刺激（DBS）过程中使用微电极记录（MER）有助于降低手术风险和副作用，并且这种技术是将病变大小最小化以及精确放置立体定向病变或DBS电极的先决条件。为了评估这些说法的一致性，我们回顾了自1992年以来发表的数百篇关于MER引导和非MER引导手术的论文和会议报告。这项综述表明，MER组的发表频率高于非MER组。虽然两组手术的副作用都并不罕见，但在消融手术和DBS手术中，使用微电极时严重并发症（如血肿）的发生率和死亡率似乎更高。此外，根据已发表的MRI图像评估，病变或DBS电极放置不准确在MER相关出版物中并不少见。当报告病变体积时，两种技术并无差异。在MER引导的手术中，用于治疗震颤的丘脑腹中间核（Vim）植入电极的刺激电参数更高。现有文献表明，与基于MRI的宏观刺激技术相比，MER技术可能会增加手术风险而不会提高其准确性。迄今为止，尚无同一组针对运动障碍手术中使用微电极与宏观电极进行的随机试验。未来进行此类试验的一个先决条件必须意味着研究人员对这两种技术持平等的无偏见态度，并且具有同等的信心和经验。由于目前在功能立体定向领域不存在这样的先决条件，对现有文献进行批判性和比较性研究仍然是评估这两种技术在靶点准确性和手术并发症方面优缺点的唯一方法。
