Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands.
Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands.
J Neurol Neurosurg Psychiatry. 2018 May;89(5):493-498. doi: 10.1136/jnnp-2017-316907. Epub 2018 Jan 20.
Individual motor improvement after deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease (PD) varies considerably. Stereotactic targeting of the dorsolateral sensorimotor part of the STN is considered paramount for maximising effectiveness, but studies employing the midcommissural point (MCP) as anatomical reference failed to show correlation between DBS location and motor improvement. The medial border of the STN as reference may provide better insight in the relationship between DBS location and clinical outcome.
Motor improvement after 12 months of 65 STN DBS electrodes was categorised into non-responding, responding and optimally responding body-sides. Stereotactic coordinates of optimal electrode contacts relative to both medial STN border and MCP served to define theoretic DBS 'hotspots'.
Using the medial STN border as reference, significant negative correlation (Pearson's correlation -0.52, P<0.01) was found between the Euclidean distance from the centre of stimulation to this DBS hotspot and motor improvement. This hotspot was located at 2.8 mm lateral, 1.7 mm anterior and 2.5 mm superior relative to the medial STN border. Using MCP as reference, no correlation was found.
The medial STN border proved superior compared with MCP as anatomical reference for correlation of DBS location and motor improvement, and enabled defining an optimal DBS location within the nucleus. We therefore propose the medial STN border as a better individual reference point than the currently used MCP on preoperative stereotactic imaging, in order to obtain optimal and thus less variable motor improvement for individual patients with PD following STN DBS.
接受丘脑底核（STN）深部脑刺激（DBS）治疗的帕金森病（PD）患者的个体运动改善程度差异很大。将 STN 的背外侧感觉运动部分进行立体定向靶向被认为是最大限度提高疗效的关键，但使用中脑连合点（MCP）作为解剖参考的研究未能显示 DBS 位置与运动改善之间的相关性。将 STN 的内侧边界作为参考可能会更好地了解 DBS 位置与临床结果之间的关系。
将 65 个 STN DBS 电极治疗 12 个月后的运动改善情况分为无反应、有反应和最佳反应的身体侧。将最佳电极接触相对于内侧 STN 边界和 MCP 的立体定向坐标用于定义理论上的 DBS“热点”。
使用内侧 STN 边界作为参考，发现刺激中心到该 DBS 热点的欧几里得距离与运动改善之间存在显著的负相关（Pearson 相关系数-0.52，P<0.01）。该热点位于内侧 STN 边界外侧 2.8mm、前方 1.7mm 和上方 2.5mm。使用 MCP 作为参考，未发现相关性。
与 MCP 相比，内侧 STN 边界作为解剖参考更能证明与 DBS 位置和运动改善相关，并且能够在核内定义最佳 DBS 位置。因此，我们建议在术前立体定向成像中，将内侧 STN 边界作为比目前使用的 MCP 更好的个体参考点，以获得接受 STN DBS 治疗的 PD 患者的个体运动改善的最佳和因此更可变。
