Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
Parkinsonism Relat Disord. 2010 Feb;16(2):96-100. doi: 10.1016/j.parkreldis.2009.07.013. Epub 2009 Aug 13.
This study analyzed risk factors for hemorrhage in a large series of deep brain stimulation (DBS) and ablation procedures in patients with advanced Parkinson's disease (PD).
Six hundred and forty four subjects with advanced PD treated with DBS or ablation procedures between March 1999 and December 2007 were enrolled in the study. Procedures were performed by the same surgeon, and included DBS in 126 patients, ablation in 507 patients and DBS after prior unilateral ablation procedures in 11 patients. Of 796 target procedures, 207 were DBS including 202 subthalamic nucleus (STN) targets, 3 ventralis intermedius nucleus (Vim) targets and 2 globus pallidus internus (GPi) targets, and the others were 589 ablation procedures including 474 GPi targets and 115 Vim targets. Postoperative CT or MRI was performed in all patients within 24 h of lead implantation or ablation treatment. Statistical correlation analysis of risk factors for intracranial hemorrhage (ICH) was performed by stepwise logistic regression. Explanatory variables were patient age, sex, blood pressure, anatomical targets, the number of microelectrode recording (MER) penetrations and surgical modality.
Postoperative symptomatic ICH occurred in 10 cases (8 pallidotomy and 2 thalamotomy) and asymptomatic ICH in 14 cases (9 pallidotomy, 4 thalamotomy and 1 DBS). Hypertension and surgical modality were significant factors contributing to hemorrhage (both P < 0.05). The likelihood of hemorrhage in hypertensive patients was 2.5 times that in normotensive patients. The risk of hemorrhage during ablation was 5.4 times that in DBS. The number of MER trajectories did not significantly correlate with ICH occurrence (P = 0.07). No statistically significant difference was found in age, sex and anatomical targets.
This study demonstrated that hypertension is a risk factor for ICH in PD patients. DBS is generally a safe surgical modality as compared with ablation. Increasing microelectrode trajectories seemed to increase the risk of ICH, but no statistically significant difference was found (P = 0.07).
本研究分析了在接受深部脑刺激（DBS）和消融治疗的晚期帕金森病（PD）患者中，导致出血的风险因素。
本研究纳入了 1999 年 3 月至 2007 年 12 月期间接受 DBS 或消融治疗的 644 名晚期 PD 患者。所有手术均由同一位外科医生进行，其中包括 126 例 DBS、507 例消融以及 11 例在单侧消融后行 DBS。796 个目标手术中，207 个为 DBS，包括 202 个丘脑底核（STN）靶点、3 个腹侧中间核（Vim）靶点和 2 个苍白球内侧核（GPi）靶点，其余 589 个为消融手术，包括 474 个 GPi 靶点和 115 个 Vim 靶点。所有患者在植入电极或消融治疗后 24 小时内行头颅 CT 或 MRI 检查。采用逐步逻辑回归法对颅内出血（ICH）的风险因素进行统计学相关性分析。解释变量包括患者年龄、性别、血压、解剖靶区、微电极记录（MER）穿刺次数和手术方式。
术后出现症状性 ICH 的患者有 10 例（8 例苍白球切开术和 2 例丘脑切开术），无症状性 ICH 的患者有 14 例（9 例苍白球切开术、4 例丘脑切开术和 1 例 DBS）。高血压和手术方式是导致出血的显著因素（均 P<0.05）。高血压患者发生出血的可能性是血压正常患者的 2.5 倍。消融手术发生出血的风险是 DBS 的 5.4 倍。MER 轨迹数量与 ICH 发生率无显著相关性（P=0.07）。年龄、性别和解剖靶区之间无统计学差异。
本研究表明，高血压是 PD 患者 ICH 的危险因素。与消融相比，DBS 通常是一种安全的手术方式。MER 轨迹数量的增加似乎会增加 ICH 的风险，但无统计学差异（P=0.07）。
