Eljamel M Sam, Tulley Mark, Spillane Kate
Department of Neurosurgery, Ninewells Hospital and Medical School, Dundee, UK.
Stereotact Funct Neurosurg. 2007;85(1):6-10. doi: 10.1159/000096633. Epub 2006 Oct 30.
Deep brain stimulation (DBS) is widely used to treat advanced Parkinson's disease, other movement and psychiatric disorders. DBS implantation requires application of a stereotactic frame throughout a lengthy procedure, making it uncomfortable and tiring. We designed a stereotactic cube to stage the operation, perform frameless microelectrode recording (MER) and fix the DBS.
The 15-mm cube is implanted in a burr hole using bone cement. It contains 5 parallel trajectories (central + 4 around). It is aligned by stereotactic frame so that central trajectory reaches the target. Frameless MER is performed by attaching a micro-driver to the cube using 2-5 cannulae (4 cm). The DBS is fixed to the cube by a mini-plate and 1 screw. Ninety-six cubes were compared with 43 Bennet spheres (BS).
No cube moved compared to 2 (5%) BS (p < 0.05). The final trajectory was central in 64.4% of cubes compared to 47.5% of BS, and the final target was >2 mm out in no cubes compared to 12.5% of BS (p < 0.01). Infection and haemorrhage were observed in 2.5% and 3.3% of cubes, respectively, while 5% of BS developed infection, 5% haemorrhage and 7.5% skin erosion.
This method is simple and effective in staging DBS procedures, performing frameless MER and DBS implantation, fixation and revision.
脑深部电刺激（DBS）广泛用于治疗晚期帕金森病及其他运动和精神疾病。DBS植入需要在整个漫长的手术过程中应用立体定向框架，这会让人感到不适和疲惫。我们设计了一种立体定向立方体来进行手术分期、进行无框架微电极记录（MER）并固定DBS。
将15毫米的立方体用骨水泥植入骨孔中。它包含5条平行轨迹（中央+周围4条）。通过立体定向框架进行对齐，使中央轨迹到达目标。通过使用2 - 5个套管（4厘米）将微驱动器连接到立方体上进行无框架MER。DBS通过一个微型板和1颗螺钉固定到立方体上。将96个立方体与43个贝内特球（BS）进行比较。
与2个（5%）BS相比，没有立方体发生移动（p < 0.05）。64.4%的立方体最终轨迹位于中央，而BS为47.5%；没有立方体的最终靶点偏离>2毫米，而BS为12.5%（p < 0.01）。立方体分别有2.5%和3.3%发生感染和出血，而BS有5%发生感染、5%出血和7.5%皮肤糜烂。
该方法在DBS手术分期、进行无框架MER以及DBS植入、固定和翻修方面简单有效。
