Andrade-Souza Yuri M, Schwalb Jason M, Hamani Clement, Eltahawy Hazem, Hoque Tasnuva, Saint-Cyr Jean, Lozano Andres M
Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
Neurosurgery. 2005 Apr;56(2 Suppl):360-8; discussion 360-8. doi: 10.1227/01.neu.0000156547.24603.ee.
The success of subthalamic nucleus (STN) surgery for Parkinson's disease depends on accuracy in target determination. The objective of this study was to determine which of the following techniques was most accurate and precise in identifying the location for stimulation in STN deep brain stimulation surgery that is most clinically effective: direct targeting, indirect targeting using the positions of the anterior and posterior commissures, or a technique using the red nucleus (RN) as an internal fiducial marker.
We reviewed 14 patients with Parkinson's disease treated with bilateral STN deep brain stimulation (28 STN targets). Electrode implantation was based on direct and indirect targeting using two-dimensional magnetic resonance imaging with refinement using microelectrode recording. Optimal settings, including the contacts used, were determined during the clinical follow-up. The position of the best contact was defined with postoperative magnetic resonance imaging. This location was compared with the modified direct, indirect, and RN-based targets. The mean distances between the targets and the final position of the optimal contact were calculated. The accuracy and variance of each target were analyzed.
The mean position of the best contact was x = 12.12 (standard deviation [SD], 1.45 mm), y = -2.41 (SD, 1.63 mm), and z = -2.39 (SD, 1.49 mm) relative to the midcommissural point. The mean distance between the optimal contact position and the planned target was 3.19 mm (SD, 1.19 mm) using the RN-based method, 3.42 mm (SD, 1.34 mm) using indirect targeting, and 4.66 mm (SD, 1.33 mm) using a modified direct target. The mean distance between the optimal contact and the RN-based target was significantly smaller than the mean distance between the optimal contact and the direct target (post hoc with Tamhane's correction, P < 0.001) but not between the optimal contact and the indirect target. The RN-based target had the smallest variance (F test, P < 0.001), indicating greater precision.
The use of the RN as an internal fiducial marker for targeting the optimal region of STN stimulation was reliable and closely approximates the position of the electrode contact that provides the optimal clinical results.
丘脑底核（STN）手术治疗帕金森病的成功取决于靶点确定的准确性。本研究的目的是确定在STN深部脑刺激手术中，以下哪种技术在确定最具临床疗效的刺激位置时最准确和精确：直接靶点定位、利用前后连合位置的间接靶点定位，还是使用红核（RN）作为内部基准标记的技术。
我们回顾了14例接受双侧STN深部脑刺激治疗的帕金森病患者（28个STN靶点）。电极植入基于使用二维磁共振成像的直接和间接靶点定位，并通过微电极记录进行优化。在临床随访期间确定最佳设置，包括使用的触点。最佳触点的位置通过术后磁共振成像确定。将该位置与改良的直接、间接和基于RN的靶点进行比较。计算靶点与最佳触点最终位置之间的平均距离。分析每个靶点的准确性和方差。
相对于连合中点，最佳触点的平均位置为x = 12.12（标准差[SD]，1.45 mm），y = -2.41（SD，1.63 mm），z = -2.39（SD，1.49 mm）。使用基于RN的方法时，最佳触点位置与计划靶点之间的平均距离为3.19 mm（SD，1.19 mm），使用间接靶点定位时为3.42 mm（SD，1.34 mm），使用改良直接靶点时为4.66 mm（SD，1.33 mm）。最佳触点与基于RN的靶点之间的平均距离显著小于最佳触点与直接靶点之间的平均距离（采用Tamhanes校正的事后检验，P < 0.001），但与最佳触点和间接靶点之间的平均距离无显著差异。基于RN的靶点方差最小（F检验，P < 0.001），表明精度更高。
使用RN作为内部基准标记来靶向STN刺激的最佳区域是可靠的，并且与提供最佳临床结果的电极触点位置非常接近。
