McClelland Shearwood, Kim Brian, Winfield Linda M, Ford Blair, Edwards Tresha A, Pullman Seth L, Yu Qiping, McKhann Guy M, Goodman Robert R
Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Neurosurg Focus. 2005 Nov 15;19(5):E13.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become a popular treatment for patients with medically refractory Parkinson disease. Many surgeons believe that microelectrode recording (MER) during DBS electrode implantation is needed to optimize placement, whereas stimulation-induced side effects such as paresthesias, dystonic contractions, dyskinesias, and ocular motor signs that become apparent postoperatively may be an indicator of the proximity of the electrode to various boundaries of the STN. This study was performed to evaluate the relationship between mapping of the STN by using MER and postoperative stimulation-induced side effects.
Eighty-two electrodes implanted in 75 patients between March 1999 and March 2003 were retrospectively examined to evaluate the length of the STN defined by MER, and the number of and threshold for postoperative stimulation-induced side effects. Electrodes were typically tested with increasing stimulation amplitudes (maximum 6 V) by using a monopolar array. The 82 electrodes were associated with 97 stimulation-induced side effects. The mean time between surgery and testing stimulation-induced side effects was 3.9 months. Statistical analysis (two-tailed t-test) revealed no significant difference in the number of stimulation-induced side effects (or the mean threshold for paresthesias, the most common side effect) for electrodes associated with an STN length less than 4.5 mm (13 electrodes) compared with those associated with an STN greater than or equal to 4.5 mm (69 electrodes, p = 0.616). For every electrode, the target adjustment based on MER results was within 2 mm of the image-planned target (usually 1 mm anterior). In the x axis (medial-lateral orientation), there was no systematic difference in adjustments made for the electrodes associated with the shorter compared with the longer STN lengths. In the y axis (anterior-posterior orientation), there was a very small statistically significant difference in the mean adjustment (0.4 mm) between the two groups.
Analysis of these results suggests that a shorter MER-determined STN length alone does not reliably predict the incidence of stimulation-induced side effects.
丘脑底核（STN）的深部脑刺激（DBS）已成为药物难治性帕金森病患者的一种常用治疗方法。许多外科医生认为，在DBS电极植入过程中需要进行微电极记录（MER）以优化电极放置，而术后出现的刺激诱发的副作用，如感觉异常、肌张力障碍性收缩、运动障碍和眼球运动体征，可能表明电极接近STN的各种边界。本研究旨在评估使用MER对STN进行图谱绘制与术后刺激诱发副作用之间的关系。
回顾性检查了1999年3月至2003年3月期间在75例患者中植入的82个电极，以评估由MER定义的STN长度，以及术后刺激诱发副作用的数量和阈值。电极通常使用单极阵列以逐渐增加的刺激幅度（最大6V）进行测试。这82个电极与97例刺激诱发的副作用相关。手术与测试刺激诱发副作用之间的平均时间为3.9个月。统计分析（双侧t检验）显示，与STN长度小于4.5mm的电极（13个电极）相比，与STN长度大于或等于4.5mm的电极（69个电极）相比，刺激诱发副作用的数量（或感觉异常这一最常见副作用的平均阈值）无显著差异（p = 0.616）。对于每个电极，基于MER结果进行的靶点调整在图像规划靶点的2mm范围内（通常在前方1mm）。在x轴（内侧-外侧方向），与较短STN长度相关的电极和与较长STN长度相关的电极在调整上没有系统差异。在y轴（前后方向），两组之间的平均调整存在非常小的统计学显著差异（0.4mm）。
对这些结果的分析表明，仅由MER确定的较短STN长度并不能可靠地预测刺激诱发副作用的发生率。
