Kochanski Ryan B, Bus Sander, Pal Gian, Metman Leo Verhagen, Sani Sepehr
Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
Section on Movement Disorders, Department of Neurology, Rush University Medical Center, Chicago, Illinois, USA.
World Neurosurg. 2017 Jul;103:168-173. doi: 10.1016/j.wneu.2017.04.003. Epub 2017 Apr 10.
Microelectrode recording (MER) is used to confirm targeting accuracy during deep brain stimulation (DBS) surgery. We describe a technique using intraoperative computed tomography (CT) extrapolation (iCTE) to predetermine and adjust the trajectory of the guide tube to improve microelectrode targeting accuracy. We hypothesized that this technique would decrease the number of MER tracks and operative time, while increasing the recorded length of the subthalamic nucleus (STN).
Thirty-nine patients with Parkinson's disease who underwent STN DBS before the iCTE method were compared with 33 patients undergoing STN DBS using iCTE. Before dural opening, a guide tube was inserted and rested on dura. Intraoperative computed tomography (iCT) was performed, and a trajectory was created along the guide tube and extrapolated to the target using targeting software. If necessary, headstage adjustments were made to correct for error. The guide tube was inserted, and MER was performed. iCT was performed with the microelectrode tip at the target. Coordinates were compared with planned/adjusted track coordinates. Radial error between the MER track and the planned/adjusted track was calculated. Cases before and after implementation of iCTE were compared to determine the impact of iCTE on operative time, number of MER tracks and recorded STN length.
The use of iCTE reduced the average radial MER track error from 1.90 ± 0.12 mm (n = 54) to 0.84 ± 0.09 mm (n = 49) (P < 0.001) while reducing the operative time for bilateral lead placement from 272 ± 9 minutes (n = 30) to 233 ± 10 minutes (n = 24) (P < 0.001). The average MER tracks per hemisphere was reduced from 2.24 ± 0.13 mm (n = 66) to 1.75 ± 0.09 mm (n = 63) (P < 0.001), whereas the percentage of hemispheres requiring a single MER track for localization increased from 29% (n = 66) to 43% (n = 63). The average length of recorded STN increased from 4.01 ± 0.3 mm (n = 64) to 4.75 ± 0.28 mm (n = 56) (P < 0.05).
iCTE improves microelectrode accuracy and increases the first-pass recorded length of STN, while reducing operative time. Further studies are needed to determine whether this technique leads to less morbidity and improved clinical outcomes.
微电极记录（MER）用于在脑深部电刺激（DBS）手术期间确认靶点准确性。我们描述了一种使用术中计算机断层扫描（CT）外推法（iCTE）来预先确定和调整导管轨迹以提高微电极靶点准确性的技术。我们假设该技术将减少MER轨迹数量和手术时间，同时增加丘脑底核（STN）的记录长度。
将39例在iCTE方法应用之前接受STN-DBS的帕金森病患者与33例使用iCTE接受STN-DBS的患者进行比较。在硬脑膜切开前，插入一根导管并使其靠在硬脑膜上。进行术中计算机断层扫描（iCT），并沿着导管创建一条轨迹，使用靶向软件将其外推至靶点。如有必要，进行头端调整以纠正误差。插入导管并进行MER。在微电极尖端位于靶点时进行iCT。将坐标与计划/调整后的轨迹坐标进行比较。计算MER轨迹与计划/调整后轨迹之间的径向误差。比较iCTE实施前后的病例，以确定iCTE对手术时间、MER轨迹数量和记录的STN长度的影响。
使用iCTE将平均径向MER轨迹误差从1.90±0.12毫米（n = 54）降至0.84±0.09毫米（n = 49）（P < 0.001），同时将双侧电极植入的手术时间从272±9分钟（n = 30）降至233±10分钟（n = 24）（P < 0.001）。每侧半球的平均MER轨迹从2.24±0.13毫米（n = 66）降至1.75±0.09毫米（n = 63）（P < 0.001），而定位时需要单个MER轨迹的半球百分比从29%（n = 66）增至43%（n = 63）。记录的STN平均长度从4.01±0.3毫米（n = 64）增至4.75±0.28毫米（n = 56）（P < 0.05）。
iCTE提高了微电极准确性，增加了STN的首次记录长度，同时减少了手术时间。需要进一步研究以确定该技术是否能降低发病率并改善临床结果。
