Candela Santiago, Vanegas María Isabel, Darling Alejandra, Ortigoza-Escobar Juan Darío, Alamar Mariana, Muchart Jordi, Climent Alejandra, Ferrer Enrique, Rumià Jordi, Pérez-Dueñas Belén
Departments of1Neurosurgery.
6Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona.
J Neurosurg Pediatr. 2018 Oct;22(4):416-425. doi: 10.3171/2018.5.PEDS1814. Epub 2018 Jul 20.
The purpose of this study was to verify the safety and accuracy of the Neuromate stereotactic robot for use in deep brain stimulation (DBS) electrode implantation for the treatment of hyperkinetic movement disorders in childhood and describe the authors' initial clinical results.
A prospective evaluation of pediatric patients with dystonia and other hyperkinetic movement disorders was carried out during the 1st year after the start-up of a pediatric DBS unit in Barcelona. Electrodes were implanted bilaterally in the globus pallidus internus (GPi) using the Neuromate robot without the stereotactic frame. The authors calculated the distances between the electrodes and their respective planned trajectories, merging the postoperative CT with the preoperative plan using VoXim software. Clinical outcome was monitored using validated scales for dystonia and myoclonus preoperatively and at 1 month and 6 months postoperatively and by means of a quality-of-life questionnaire for children, administered before surgery and at 6 months' follow-up. We also recorded complications derived from the implantation technique, "hardware," and stimulation.
Six patients aged 7 to 16 years and diagnosed with isolated dystonia ( DYT1 negative) (3 patients), choreo-dystonia related to PDE2A mutation (1 patient), or myoclonus-dystonia syndrome SGCE mutations (2 patients) were evaluated during a period of 6 to 19 months. The average accuracy in the placement of the electrodes was 1.24 mm at the target point. At the 6-month follow-up, patients showed an improvement in the motor (65%) and functional (48%) components of the Burke-Fahn-Marsden Dystonia Rating Scale. Patients with myoclonus and SGCE mutations also showed an improvement in action myoclonus (95%-100%) and in functional tests (50%-75%) according to the Unified Motor-Rating Scale. The Neuro-QOL score revealed inconsistent results, with improvement in motor function and social relationships but worsening in anxiety, cognitive function, and pain. The only surgical complication was medial displacement of the first electrode, which limited intensity of stimulation in the lower contacts, in one case.
The Neuromate stereotactic robot is an accurate and safe tool for the placement of GPi electrodes in children with hyperkinetic movement disorders.
本研究旨在验证Neuromate立体定向机器人在用于治疗儿童运动亢进性运动障碍的脑深部电刺激（DBS）电极植入中的安全性和准确性，并描述作者的初步临床结果。
在巴塞罗那一家儿科DBS单元启动后的第1年，对患有肌张力障碍和其他运动亢进性运动障碍的儿科患者进行了前瞻性评估。使用Neuromate机器人在无立体定向框架的情况下双侧植入内侧苍白球（GPi）电极。作者使用VoXim软件将术后CT与术前计划合并，计算电极与其各自计划轨迹之间的距离。术前、术后1个月和6个月使用经过验证的肌张力障碍和肌阵挛量表监测临床结果，并在手术前和随访6个月时通过儿童生活质量问卷进行监测。我们还记录了植入技术、“硬件”和刺激引起的并发症。
在6至19个月的时间里，对6例年龄在7至16岁、诊断为孤立性肌张力障碍（DYT1阴性）（3例）、与PDE2A突变相关的舞蹈性肌张力障碍（1例）或肌阵挛性肌张力障碍综合征SGCE突变（2例）的患者进行了评估。电极放置的平均准确性在靶点处为1.24毫米。在6个月的随访中，患者在伯克-法恩-马斯登肌张力障碍评定量表的运动（65%）和功能（48%）方面有所改善。根据统一运动评定量表，患有肌阵挛和SGCE突变的患者在动作性肌阵挛（95%-100%）和功能测试（50%-75%）方面也有所改善。神经生活质量评分结果不一致，运动功能和社会关系有所改善，但焦虑、认知功能和疼痛方面有所恶化。唯一的手术并发症是1例患者的第一根电极向内侧移位，这限制了较低触点的刺激强度。
Neuromate立体定向机器人是在患有运动亢进性运动障碍的儿童中放置GPi电极的准确且安全的工具。
