Bentley J Nicole, Guan Zhe, Cummings Karen S, Chou Kelvin L, Patil Parag G
Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
Stereotact Funct Neurosurg. 2017;95(1):6-12. doi: 10.1159/000452843. Epub 2017 Jan 14.
The introduction of intracranial air during deep brain stimulation (DBS) surgery is believed to negatively impact targeting accuracy and clinical outcomes.
To quantify the relationship between intracranial air (ICA) volumes, targeting accuracy, and clinical outcomes in patients undergoing subthalamic nucleus (STN) DBS for Parkinson's disease.
ICA in 73 consecutive STN DBS cases (146 leads) was measured by high-resolution CT and correlated with proximal lead bowing, electrode displacement, targeting accuracy, and clinical outcomes at 6 and 12 months.
There was a statistically significant correlation of ICA volume (mean ± SEM: 21.3 ± 13.7 cm3) and proximal lead bowing (2.8 ± 1.4 mm, r = 0.34, p = 0.01). There was no significant correlation of ICA with targeting error (2.0 ± 1.2 mm), distal contact deviation (1.2 ± 0.7 mm), motor Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part III improvement at 6 months (42.3 ± 4.5%) or 12 months (30.3 ± 7.7%), or dopaminergic medication reduction at 6 months (44.7± 4.2%) or 12 months (32.9 ± 5.9%). Comparison of top and bottom ICA quintile extremes also revealed no differences in these measures.
Though the proximal DBS lead bends in association with ICA, movement of the distal contact, targeting error, and clinical outcomes are not affected by ICA. This unexpected finding is maintained at ICA quintile extremes.
在脑深部电刺激（DBS）手术中引入颅内空气被认为会对靶点定位准确性和临床疗效产生负面影响。
量化接受丘脑底核（STN）DBS治疗帕金森病患者的颅内空气（ICA）体积、靶点定位准确性和临床疗效之间的关系。
通过高分辨率CT测量73例连续STN DBS病例（146根电极）中的ICA，并将其与近端电极弯曲、电极移位、靶点定位准确性以及6个月和12个月时的临床疗效进行关联分析。
ICA体积（均值±标准误：21.3±13.7 cm³）与近端电极弯曲（2.8±1.4 mm，r = 0.34，p = 0.01）之间存在统计学显著相关性。ICA与靶点误差（2.0±1.2 mm）、远端触点偏差（1.2±0.7 mm）、6个月时运动障碍协会统一帕金森病评定量表第三部分改善情况（42.3±4.5%）或12个月时（30.3±7.7%），以及6个月时（44.7±4.2%）或12个月时（32.9±5.9%）的多巴胺能药物减少量均无显著相关性。对ICA五分位数最高和最低极端值的比较也显示这些指标没有差异。
虽然近端DBS电极会随着ICA弯曲，但远端触点的移动、靶点误差和临床疗效不受ICA影响。这一意外发现在ICA五分位数极端值时依然成立。
