Matias Caio M, Mehanna Raja, Cooper Scott E, Amit Amit, Lempka Scott F, Silva Danilo, Carlotti Carlos G, Butler Robert S, Machado Andre G
*Center for Neurological Restoration, Cleveland Clinic Neurological Institute, Cleveland, Ohio; ‡Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; §University of Texas Health Science Center, Houston, Texas; ¶Department of Neurology, Cleveland Clinic Neurological Institute, Cleveland, Ohio; ‖Department of Neurosurgery, Cleveland Clinic Neurological Institute, Cleveland, Ohio; #Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
Neurosurgery. 2015 Mar;11 Suppl 2:99-108; discussion 108-9. doi: 10.1227/NEU.0000000000000645.
Clinical benefits of deep brain stimulation can be limited by the presence of side effects produced by current spread to adjacent structures.
To identify a correlation between coordinates for each individual contact, neighboring structures, and pattern of side effects.
Coordinates of the electrodes and anatomic landmarks were obtained with a stereotactic surgical planning software and were correlated with stimulation-related side effects by using univariate and multivariable analyses.
Monopolar stimulation elicited capsular side effects (CSEs) in 208 of 316 contacts (65.8%) and noncapsular side effects (NCSEs) in 223 of 316 contacts (70.6%). The occurrence of CSEs was correlated with contact number (P = .009) and with the "Z" (P = .03), whereas voltage threshold to CSEs exhibited correlation with the internal capsule angle (P = .035). The occurrence of NCSEs was correlated with contact number (P = .005), "X" (P = .03), "Y" (P = .004), and the distance to the red nucleus (P = .001 and P = .003). There was correlation between voltage threshold to NCSEs and the internal capsule angle (P = .006), electrode's coronal angle (P = .02), "X" (P = .001), "Y" (P < .001), "Z" (P < .001), and the distances to the internal capsule (P = .02) and to the red nucleus (P = .004 and P < .001).
A better understanding how patient anatomy, stimulation parameters, and lead location in relation to neighboring structures influence the occurrence of side effects can be useful to inform targeting strategies.
深部脑刺激的临床益处可能会受到电流扩散至相邻结构所产生的副作用的限制。
确定每个单独触点的坐标、相邻结构与副作用模式之间的相关性。
使用立体定向手术规划软件获取电极坐标和解剖标志，并通过单变量和多变量分析将其与刺激相关的副作用相关联。
316个触点中有208个（65.8%）在单极刺激时引发了囊膜副作用（CSE），316个触点中有223个（70.6%）引发了非囊膜副作用（NCSE）。CSE的发生与触点数量（P = .009）和“Z”（P = .03）相关，而CSE的电压阈值与内囊角度相关（P = .035）。NCSE的发生与触点数量（P = .005）、“X”（P = .03）、“Y”（P = .004）以及与红核的距离（P = .001和P = .003）相关。NCSE的电压阈值与内囊角度（P = .006）、电极的冠状角（P = .02）、“X”（P = .001）、“Y”（P < .001）、“Z”（P < .001）以及与内囊的距离（P = .02）和与红核的距离（P = .004和P < .001）相关。
更好地了解患者解剖结构、刺激参数以及电极相对于相邻结构的位置如何影响副作用的发生，有助于指导靶向策略。
