Department of Neurosurgery, First Medical Center of PLA General Hospital, Beijing, 100853, People's Republic of China.
Acta Neurochir (Wien). 2019 Aug;161(8):1545-1558. doi: 10.1007/s00701-019-03929-x. Epub 2019 May 3.
Although intracerebral hemorrhage is the most feared complication of deep brain stimulation (DBS) surgery, cerebral ischemic events in association with DBS surgery have only rarely been described. We therefore evaluated the role of intraoperative MRI (iMRI) for early identification of cerebral ischemic events during DBS procedures and determined how ischemic infarctions affect patients over acute and long-term periods.
Between January 2010 and December 2017, 1160 DBS electrodes were implanted in 595 patients at Chinese People's Liberation Army General Hospital, with the help of iMRI. The iMRI was performed in all patients after implantation, to define the accuracy of lead placement and detect complications. A CT scan was performed on postoperative days 1 to 7.
The iMRI showed that cerebral ischemic changes happened in nine (1.51% of patients, 0.78% of leads) patients. Only two (0.34%) of nine patients had an ischemic infarction in the basal ganglia, while seven (1.18%) had cortical ischemia. Six (67%) of the nine patients had long-term complications, two with mild hemiparesis, two with seizures, one with language dysfunction, and one with memory loss. Of those with a cortical ischemic infarction, only three (42.86%) of seven patients had no long-term complications. Long-term follow-up imaging showed that not all the patients recovered normal morphological structure in the area of ischemic foci. The factors of sex, age, target, and anesthesia were not related to ischemic events. In six (66.7%) cases, the entry point on the cortex or the path was not ideal.
Intraoperative ischemic events are not uncommon in DBS surgery. Ischemia can cause serious permanent complications, and regions subject to severe ischemia cannot be restored; it is therefore necessary to pay careful attention to any signs of ischemia. iMRI objectively provides the basis for early diagnosis of intraoperative ischemic infarction, providing guidance for follow-up treatment. The deviation in the entry point on the cortex or in the path resulted in vascular injury; it may be the key cause of ischemic events during DBS procedures.
尽管脑出血是深部脑刺激（DBS）手术最令人担忧的并发症，但与 DBS 手术相关的脑缺血事件很少被描述。因此，我们评估了术中磁共振成像（iMRI）在 DBS 手术过程中早期识别脑缺血事件的作用，并确定了缺血性梗死在急性和长期内对患者的影响。
2010 年 1 月至 2017 年 12 月，在中国人民解放军总医院，595 例患者共植入了 1160 个 DBS 电极，术中使用了 iMRI。所有患者在植入后均进行 iMRI，以确定导联放置的准确性并检测并发症。术后 1-7 天进行 CT 扫描。
iMRI 显示 9 例（1.51%的患者，0.78%的导联）患者出现脑缺血性改变。仅 2 例（0.34%）患者基底节区出现缺血性梗死，7 例（1.18%）患者出现皮质缺血。9 例患者中有 6 例（67%）出现长期并发症，其中 2 例表现为轻度偏瘫，2 例表现为癫痫发作，1 例表现为语言功能障碍，1 例表现为记忆力减退。7 例皮质缺血患者中，仅 3 例（42.86%）无长期并发症。长期随访影像学显示，并非所有患者在缺血灶区域的形态结构均恢复正常。性别、年龄、靶点和麻醉等因素与缺血事件无关。在 6 例（66.7%）患者中，皮质的入点或路径不理想。
DBS 手术中术中缺血事件并不少见。缺血可导致严重的永久性并发症，且严重缺血区域无法恢复；因此，有必要密切注意任何缺血迹象。iMRI 客观地为术中缺血性梗死的早期诊断提供了依据，为后续治疗提供了指导。皮质入点或路径的偏差导致血管损伤，可能是 DBS 手术中发生缺血事件的关键原因。
