Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China; The First Clinical Medical College of Nanchang University, Nanchang, Jiangxi, PR China.
Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China; The Second Clinical Medical College of Nanchang University, Nanchang, Jiangxi, PR China.
Brain Stimul. 2019 Jul-Aug;12(4):893-900. doi: 10.1016/j.brs.2019.03.006. Epub 2019 Mar 7.
Deep brain stimulation (DBS) is a well-established surgical therapy for Parkinson's disease (PD). Intraoperative imaging (IMG), intraoperative physiology (PHY) and their combination (COMB) are the three mainstream DBS guidance methods.
To comprehensively compare the use of IMG-DBS, PHY-DBS and COMB-DBS in treating PD.
PubMed, Embase, the Cochrane Library and OpenGrey were searched to identify PD-DBS studies reporting guidance techniques published between January 1, 2010, and May 1, 2018. We quantitatively compared the therapeutic effects, surgical time, target error and complication risk and qualitatively compared the patient experience, cost and technical prospects. A meta-regression analysis was also performed. This study is registered with PROSPERO, number CRD42018105995.
Fifty-nine cohorts were included in the main analysis. The three groups were equivalent in therapeutic effects and infection risks. IMG-DBS (p < 0.001) and COMB-DBS (p < 0.001) had a smaller target error than PHY-DBS. IMG-DBS had a shorter surgical time (p < 0.001 and p = 0.008, respectively) and a lower intracerebral hemorrhage (ICH) risk (p = 0.013 and p = 0.004, respectively) than PHY- and COMB-DBS. The use of intraoperative imaging and microelectrode recording correlated with a higher surgical accuracy (p = 0.018) and a higher risk of ICH (p = 0.049).
The comparison of COMB-DBS and PHY-DBS showed intraoperative imaging's superiority (higher surgical accuracy), while the comparison of COMB-DBS and IMG-DBS showed physiological confirmation's inferiority (longer surgical time and higher ICH risk). Combined with previous evidence, the use of intraoperative neuroimaging techniques should become a future trend.
深部脑刺激（DBS）是一种成熟的帕金森病（PD）手术治疗方法。术中影像（IMG）、术中生理学（PHY）及其组合（COMB）是三种主流的 DBS 引导方法。
全面比较 IMG-DBS、PHY-DBS 和 COMB-DBS 治疗 PD 的效果。
检索 PubMed、Embase、Cochrane 图书馆和 OpenGrey，以确定 2010 年 1 月 1 日至 2018 年 5 月 1 日期间发表的报告 DBS 引导技术的 PD-DBS 研究。我们对治疗效果、手术时间、靶点误差和并发症风险进行了定量比较，并对患者体验、成本和技术前景进行了定性比较。还进行了元回归分析。本研究已在 PROSPERO 注册，编号为 CRD42018105995。
主要分析纳入了 59 项队列研究。三组在治疗效果和感染风险方面无差异。与 PHY-DBS 相比，IMG-DBS（p<0.001）和 COMB-DBS（p<0.001）靶点误差更小。与 PHY-DBS 和 COMB-DBS 相比，IMG-DBS 手术时间更短（p<0.001 和 p=0.008），颅内出血（ICH）风险更低（p=0.013 和 p=0.004）。术中影像和微电极记录的应用与更高的手术准确性（p=0.018）和更高的 ICH 风险（p=0.049）相关。
与 PHY-DBS 相比，COMB-DBS 比较显示术中影像具有优势（更高的手术准确性），而 COMB-DBS 与 IMG-DBS 比较显示生理确认具有劣势（更长的手术时间和更高的 ICH 风险）。结合以往的证据，术中神经影像学技术的应用应该成为未来的趋势。
