Liu Xuemeng, Zhang Jibo, Fu Kai, Gong Rui, Chen Jincao, Zhang Jie
Department of Neurosurgery, ZhongNan Hospital WuHan University, WuHan, China; Parkinson's Disease Research Center, ZhongNan Hospital WuHan University, WuHan, China.
Department of Neurosurgery, ZhongNan Hospital WuHan University, WuHan, China.
World Neurosurg. 2017 Nov;107:900-905. doi: 10.1016/j.wneu.2017.08.077. Epub 2017 Aug 24.
Microelectrode recording (MER) and intraoperative magnetic resonance imaging (iMRI) have been used in deep brain stimulation surgery for Parkinson disease (PD), but comparative methodology is lacking. Therefore, we compared the 1-year follow-up outcomes of MER-guided and iMRI-guided subthalamic nucleus (STN) deep brain stimulation (DBS) surgery in PD patients.
We conducted a review comparing PD patients who underwent MER-guided (n = 76, group A) and iMRI-guided STN DBS surgery (n = 61, group B) in our institution. Pre- and postoperative assessments included Unified Parkinson's Disease Rating Scale-III (UPDRS-III) score, Parkinson's Disease Questionnaire (PDQ-39), Mini-Mental State Examination (MMSE), levodopa equivalent daily doses (LEDDs), and magnetic resonance images.
The mean magnitudes of electrode discrepancy were x = 1.1 ± 0.2 mm, y = 1.3 ± 0.3 mm, and z = 2.1 ± 0.5 mm in group A and x = 1.3 ± 0.4 mm, y = 1.2 ± 0.2 mm, and z = 2.5 ± 0.7 mm in group B. Significant differences were not found between 2 groups for x, y, or z (P = 0.34, P = 0.26, and P = 0.41, respectively). At 1 year, when levodopa was withdrawn for 12 hours, the UPDRS-III score improved by 66.3% ± 13.5% in group A and 64.8% ± 12.7% in group B (P = 0.24); the PDQ-39 summary index score improved by 49.7% ± 14.3% in group A and 44.1% ± 12.7% in group B (P = 0.16); the MMSE score improved by 4.2% ± 2.1% in group A and 11.1% ± 3.2% in group B (P = 0.43); and LEDDs decreased by 48.7% ± 10.1% in group A and 56.9% ± 12.0% in group B (P = 0.32).
MER and iMRI both are effective ways to ensure adequate electrode placement in DBS surgery, but there is no superiority between both techniques, at least in terms of 1-year follow-up outcomes.
微电极记录（MER）和术中磁共振成像（iMRI）已用于帕金森病（PD）的脑深部电刺激手术，但缺乏比较方法。因此，我们比较了PD患者中MER引导和iMRI引导的丘脑底核（STN）脑深部电刺激（DBS）手术的1年随访结果。
我们进行了一项回顾性研究，比较了在我院接受MER引导（n = 76，A组）和iMRI引导的STN DBS手术（n = 61，B组）的PD患者。术前和术后评估包括统一帕金森病评定量表第三部分（UPDRS-III）评分、帕金森病问卷（PDQ-39）、简易精神状态检查表（MMSE）、左旋多巴等效日剂量（LEDDs）以及磁共振图像。
A组电极差异的平均幅度为x = 1.1±0.2 mm，y = 1.3±0.3 mm，z = 2.1±0.5 mm；B组为x = 1.3±0.4 mm，y = 1.2±0.2 mm，z = 2.5±0.7 mm。两组在x、y或z方面均未发现显著差异（P分别为0.34、0.26和0.41）。在1年时，当停用左旋多巴12小时后，A组UPDRS-III评分改善了66.3%±13.5%，B组改善了64.8%±12.7%（P = 0.24）；A组PDQ-39总结指数评分改善了49.7%±14.3%，B组改善了44.1%±12.7%（P = 0.16）；A组MMSE评分改善了4.2%±2.1%，B组改善了11.1%±3.2%（P = 0.43）；A组LEDDs下降了48.7%±10.1%，B组下降了56.9%±12.0%（P = 0.32）。
MER和iMRI都是确保DBS手术中电极放置合适的有效方法，但至少在1年随访结果方面，两种技术之间没有优越性。
