Sharim Justin, Yazdi Daniel, Baohan Amy, Behnke Eric, Pouratian Nader
Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Department of Bioengineering, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Neuromodulation. 2017 Apr;20(3):238-242. doi: 10.1111/ner.12480. Epub 2016 Jul 28.
Neurosurgical interventions such as deep brain stimulation surgery of the globus pallidus internus (GPi) play an important role in the treatment of medically refractory Parkinson's disease (PD), and require high targeting accuracy. Variability in the laterality of the GPi across patients with PD has not been well characterized. The aim of this report is to identify factors that may contribute to differences in position of the motor region of GPi.
The charts and operative reports of 101 PD patients following deep brain stimulation surgery (70 males, aged 11-78 years) representing 201 GPi were retrospectively reviewed. Data extracted for each subject include age, gender, anterior and posterior commissures (AC-PC) distance, and third ventricular width. Multiple linear regression, stepwise regression, and relative importance of regressors analysis were performed to assess the predictive ability of these variables on GPi laterality.
Multiple linear regression for target vs. third ventricular width, gender, AC-PC distance, and age were significant for normalized linear regression coefficients of 0.333 (p < 0.0001), 0.206 (p = 0.00219), 0.168 (p = 0.0119), and 0.159 (p = 0.0136), respectively. Third ventricular width, gender, AC-PC distance, and age each account for 44.06% (21.38-65.69%, 95% CI), 20.82% (10.51-35.88%), 21.46% (8.28-37.05%), and 13.66% (2.62-28.64%) of the R value, respectively. Effect size calculation was significant for a change in the GPi laterality of 0.19 mm per mm of ventricular width, 0.11 mm per mm of AC-PC distance, 0.017 mm per year in age, and 0.54 mm increase for male gender.
This variability highlights the limitations of indirect targeting alone, and argues for the continued use of MRI as well as intraoperative physiological testing to account for such factors that contribute to patient-specific variability in GPi localization.
神经外科手术干预，如内侧苍白球（GPi）的脑深部电刺激手术，在药物难治性帕金森病（PD）的治疗中发挥着重要作用，且需要高精度的靶点定位。PD患者中GPi的左右侧差异尚未得到充分描述。本报告的目的是确定可能导致GPi运动区域位置差异的因素。
回顾性分析101例接受脑深部电刺激手术的PD患者（70例男性，年龄11 - 78岁）的病历和手术报告，共涉及201个GPi。为每个受试者提取的数据包括年龄、性别、前后连合（AC - PC）距离和第三脑室宽度。进行多元线性回归、逐步回归和回归因子相对重要性分析，以评估这些变量对GPi左右侧性的预测能力。
目标值与第三脑室宽度、性别、AC - PC距离和年龄的多元线性回归对于标准化线性回归系数分别为0.333（p < 0.0001）、0.206（p = 0.00219）、0.168（p = 0.0119）和0.159（p = 0.0136）时具有显著性。第三脑室宽度、性别、AC - PC距离和年龄分别占R值的44.06%（21.38 - 65.69%，95%可信区间）、20.82%（10.51 - 35.88%）、21.46%（8.28 - 37.05%）和13.66%（2.62 - 28.64%）。效应量计算显示，第三脑室宽度每增加1毫米，GPi左右侧性变化0.19毫米；AC - PC距离每增加1毫米，变化0.11毫米；年龄每增加1岁，变化0.017毫米；男性则增加0.54毫米，差异均具有显著性。
这种变异性凸显了仅靠间接靶点定位的局限性，支持继续使用MRI以及术中生理测试来考虑这些导致GPi定位存在个体差异的因素。
