Richardson R Mark, Ostrem Jill L, Starr Philip A
Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA.
Stereotact Funct Neurosurg. 2009;87(5):297-303. doi: 10.1159/000230692. Epub 2009 Jul 29.
There is no clear consensus regarding the optimal location for placing deep brain stimulation (DBS) electrodes within the subthalamic nucleus (STN) target region in Parkinson's disease. In cases of poor symptom control or adverse effects following lead placement, leads presumed to be inadequately positioned may be corrected by surgical revision. We retrospectively analyzed a series of 8 patients who underwent surgical lead revision, to study the anatomic boundaries of effective lead placement. Reoperation to achieve changes of 2-5 mm in DBS lead position targeting the dorsolateral part of the STN produced significant clinical improvement in these patients. Improvements were due to better symptom control, reduction of stimulation-induced adverse effects or both. In many cases, leads in a peripheral zone of the STN were repositioned to a more central location within the sensorimotor territory of the nucleus. These results are contrasted with findings in other studies demonstrating optimal lead placement in STN border zones or neighboring white-matter tracts.
关于帕金森病中在丘脑底核（STN）目标区域内放置脑深部电刺激（DBS）电极的最佳位置，目前尚无明确的共识。在电极植入后症状控制不佳或出现不良反应的情况下，推测位置不当的电极可通过手术修正来校正。我们回顾性分析了一系列8例接受手术电极修正的患者，以研究有效电极放置的解剖边界。以STN背外侧部分为靶点，将DBS电极位置改变2 - 5毫米的再次手术使这些患者的临床症状得到了显著改善。改善的原因是症状得到更好的控制、刺激引起的不良反应减少或两者兼有。在许多情况下，STN外周区域的电极被重新放置到核团感觉运动区域内更中心的位置。这些结果与其他研究中显示在STN边界区域或相邻白质束中最佳电极放置的结果形成对比。
