Voges J, Kiening K, Krauss J K, Nikkhah G, Vesper J
Universitätsklinik für Stereotaktische Neurochirurgie, Universitätsklinikum A.ö.R., Leipziger Strasse 44, 39120, Magdeburg, Deutschland.
Nervenarzt. 2009 Jun;80(6):666-72. doi: 10.1007/s00115-009-2698-0.
Surgery combining stereotactically guided implantation of brain electrodes in subcortical key structures of the brain with the connection of these brain electrodes to subcutaneously implanted impulse generators is one precondition for the therapeutic application of deep brain stimulation (DBS). During the last 10-15 years minimal requirements concerning this surgery have been formulated, addressing in particular technical equipment and operational procedures and being also in parts supported quantitatively by systematic investigations. Only appropriate patient management, high technical standards and an adequate surgical technique can minimize the frequency of those complications, which are supposed to be directly caused by surgery. High-resolution imaging is the basis for target definition, determination of the surgical approach, documentation of final electrode position and postoperative exclusion of iatrogenic intracerebral haemorrhage. In addition, the quality of treatment planning depends largely on the image processing and viewing possibilities provided by specific planning software. Further issues, for which standards are defined, address electrophysiological and clinical examinations to be performed intraoperatively and general surgical measures, which should be considered during implantation of DBS systems. This review summarizes and evaluates requirements imposed on the aforementioned system components and working steps, taking into consideration data from the literature.
将立体定向引导的脑电极植入脑皮质下关键结构并将这些脑电极与皮下植入的脉冲发生器相连的手术，是深部脑刺激（DBS）治疗应用的一个前提条件。在过去10至15年里，已经制定了关于该手术的最低要求，特别涉及技术设备和操作程序，并且部分要求也得到了系统研究的定量支持。只有恰当的患者管理、高技术标准和适当的手术技术，才能将那些被认为直接由手术引起的并发症的发生率降至最低。高分辨率成像对于靶点定义、手术入路的确定、最终电极位置的记录以及术后排除医源性脑出血至关重要。此外，治疗计划的质量在很大程度上取决于特定计划软件提供的图像处理和观察可能性。已定义标准的其他问题包括术中应进行的电生理和临床检查，以及在植入DBS系统时应考虑的一般外科措施。本综述考虑文献数据，总结并评估了对上述系统组件和工作步骤的要求。
