Department of Neurosurgery, CHU Pontchaillou, Rennes, France.
INSERM, LTSI U1099, Faculté de Médecine, Rennes, France.
PLoS One. 2018 Jul 13;13(7):e0200262. doi: 10.1371/journal.pone.0200262. eCollection 2018.
Anatomical atlases have been developed to improve the targeting of basal ganglia in deep brain stimulation. However, the sole anatomy cannot predict the functional outcome of this surgery. Deep brain stimulation is often a compromise between several functional outcomes: motor, fluency and neuropsychological outcomes in particular. In this study, we have developed anatomo-clinical atlases for the targeting of subthalamic and medial globus pallidus deep brain stimulation. The activated electrode coordinates of 42 patients implanted in the subthalamic nucleus and 29 patients in the medial globus pallidus were studied. The atlas was built using the representation of the volume of tissue theoretically activated by the stimulation. The UPDRS score was used to represent the motor outcome. The Stroop test was represented as well as semantic and phonemic fluencies. For the subthalamic nucleus, best motor outcomes were obtained when the supero-lateral part of the nucleus was stimulated whereas the semantic fluency was impaired in this same region. For the medial globus pallidus, best outcomes were obtained when the postero ventral part of the nucleus was stimulated whereas the phonemic fluency was impaired in this same region. There was no significant neuropsychological impairment. We have proposed new anatomo-clinical atlases to visualize the motor and neuropsychological consequences at 6 months of subthalamic nucleus and pallidal stimulation in patients with Parkinson's disease.
解剖图谱被开发出来以提高深部脑刺激中基底节的靶向性。然而，仅靠解剖结构并不能预测手术的功能结果。深部脑刺激通常是几个功能结果之间的折衷：特别是运动、流畅性和神经心理学结果。在这项研究中，我们开发了用于亚丘脑和内侧苍白球深部脑刺激靶向的解剖学-临床图谱。研究了 42 名植入丘脑底核和 29 名植入内侧苍白球的患者的激活电极坐标。图谱是使用刺激理论上激活的组织体积表示来构建的。UPDRS 评分用于表示运动结果。还表示了 Stroop 测试以及语义和语音流畅性。对于丘脑底核，当刺激核的上外侧部分时，可获得最佳的运动结果，而在同一区域，语义流畅性受到损害。对于内侧苍白球，当刺激核的后腹侧部分时，可获得最佳结果，而在同一区域，语音流畅性受到损害。没有明显的神经心理学损伤。我们提出了新的解剖学-临床图谱，以可视化帕金森病患者深部脑刺激丘脑底核和苍白球 6 个月后的运动和神经心理学后果。
