DiLorenzo Daniel J, Jankovic Joseph, Simpson Richard K, Takei Hidehiro, Powell Suzanne Z
Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA.
Neuromodulation. 2014 Jul;17(5):405-18; discussion 418. doi: 10.1111/ner.12192. Epub 2014 Jun 20.
Despite the widespread use of deep brain stimulation (DBS) in the treatment of neurologic disorders for over a quarter of a century, there has not been a systematic review and analyses of cases in which long-term postmortem clinic-pathologic data have been collected demonstrating the effects of chronically implanted electrodes and electrical stimulation on human brain tissue. Our objective is to provide a comprehensive systematic review of the literature on clinicopathologic findings of DBS tissue-electrode interface (TEI) and to determine types and prevalences of neuropathological findings among electrode materials and stimulation parameters and to augment this with previously unpublished histopathological data, images, and analyses from a DBS case implanted for 12 years, providing the longest duration histopathological follow-up.
A Medline literature review identified DBS cases upon which postmortem clinicopathologic follow-up was performed with adequate characterization of TEI. Direct follow-up with authors augmented this with unpublished data and neuropathological details.
We identified 40 cases, mean age 59.1 ± 13.0 (range: 21-88) years, involving 58 implanted DBS electrodes. The mean postmortem histopathological follow-up of the implanted DBS electrodes was 22.2 ± 29.2 (range: 0.067-146) months, including our case with a 12-year follow-up. The following histological changes were identified: fibrous sheaths (5-25 μm thickness) surrounding the electrode (94%), fibrillary gliosis (73%), reactive astrocytes (78%), multinucleated giant cells (75%), mononuclear leukocytes (92%), and macrophages (91%). Microglial activation (60%), axonal spheroids (64%), and neuronal loss (60%) were less common and absent at 12-year follow-up in the index case. This is seventh case reporting T cell presence at the TEI.
Neuropathological findings from published cases and our 12-year follow-up index case confirm the long-term safety of neuromodulation and stimulation thresholds and demonstrate persistence of T cells and occasional subclinical focal tissue injury.
尽管深部脑刺激（DBS）在治疗神经系统疾病方面已广泛应用了25年有余，但尚未有系统回顾和分析收集了长期尸检临床病理数据以证明长期植入电极及电刺激对人脑组织影响的病例。我们的目的是对DBS组织-电极界面（TEI）的临床病理结果相关文献进行全面系统回顾，确定电极材料和刺激参数中神经病理学发现的类型及发生率，并补充来自一例植入12年的DBS病例的未发表组织病理学数据、图像及分析，该病例提供了最长时间的组织病理学随访。
通过Medline文献回顾确定了进行了尸检临床病理随访且对TEI有充分特征描述的DBS病例。与作者直接随访补充了未发表的数据及神经病理学细节。
我们确定了40例病例，平均年龄59.1±13.0（范围：21 - 88）岁，涉及58个植入的DBS电极。植入的DBS电极平均尸检组织病理学随访时间为22.2±29.2（范围：0.067 - 146）个月，包括我们随访12年的病例。发现了以下组织学变化：电极周围有纤维鞘（厚度5 - 25μm）（94%）、纤维性胶质增生（73%）、反应性星形胶质细胞（78%）、多核巨细胞（75%）、单核白细胞（92%）和巨噬细胞（91%）。小胶质细胞活化（60%）、轴突球（64%）和神经元丢失（60%）较少见，在索引病例的12年随访中未出现。这是第七例报告TEI处存在T细胞的病例。
已发表病例及我们12年随访索引病例的神经病理学发现证实了神经调节和刺激阈值的长期安全性，并证明了T细胞的持续存在及偶尔的亚临床局灶性组织损伤。
