Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
Section on Movement Disorders, Department of Neurology, Rush University Medical Center, Chicago, Illinois, USA.
World Neurosurg. 2019 Dec;132:e487-e495. doi: 10.1016/j.wneu.2019.08.092. Epub 2019 Aug 23.
During deep brain stimulation (DBS) surgery, microelectrode recording (MER) leads to target refinement from the initial plan in 30% to 47% of hemispheres; however, it is unclear whether the DBS lead ultimately resides within the MER-optimized target in relation to initial radiographic target coordinates in these hemispheres. This study aimed to determine the frequency of discordance between radiographic and neurophysiologic nucleus and whether target optimization with MER leads to a significant change in DBS lead location away from initial target.
Consecutive cases of DBS surgery with MER using intraoperative computed tomography were included. Coordinates of initial anatomic target (AT), MER-optimized target (MER-O) and DBS lead were obtained. Hemispheres were categorized as "discordant" (D) if there was a suboptimal neurophysiologic signal despite accurate targeting of AT. Hemispheres where the first MER pass was satisfactory were deemed "concordant" (C). Coordinates and radial distances between 1) AT/MER-O; 2) MER-O/DBS; and 3) AT/DBS were calculated and compared.
Of the 273 hemispheres analyzed, 143 (52%) were D, and 130 (48%) were C. In C hemispheres, DBS lead placement error (mean ± standard error of the mean) was 0.88 ± 0.07 mm. In D hemispheres, MER resulted in significant migration of DBS lead (mean AT-DBS error 2.11 ± 0.07 mm), and this distance was significantly greater than the distance between MER-O and DBS (2.11 vs. 1.09 mm, P < 0.05). Directional assessment revealed that the DBS lead migrated in the intended direction as determined by MER-O in D hemispheres, except when the intended direction was anterolateral.
Discordance between radiographic and neurophysiologic target was seen in 52% of hemispheres, and MER resulted in appropriate deviation of the DBS lead toward the appropriate target. The actual value of the deviation, when compared with DBS lead placement error in C hemispheres, was, on average, small.
在脑深部刺激（DBS）手术中，微电极记录（MER）导致 30%至 47%的半球从初始计划中对目标进行细化；然而，目前尚不清楚在这些半球中，MER 优化后的目标与初始放射学目标坐标相比，DBS 导联最终是否位于 MER 优化后的目标内。本研究旨在确定放射学和神经生理学核之间的不匹配频率，以及 MER 引导的目标优化是否会导致 DBS 导联位置明显偏离初始目标。
纳入了使用术中计算机断层扫描进行 MER 的连续 DBS 手术病例。获得初始解剖目标（AT）、MER 优化目标（MER-O）和 DBS 导联的坐标。如果存在神经生理学信号不理想但 AT 定位准确的情况，则将半球归类为“不匹配”（D）。如果第一个 MER 测试结果满意，则将半球视为“匹配”（C）。计算并比较 1）AT/MER-O；2）MER-O/DBS；和 3）AT/DBS 之间的坐标和径向距离。
在分析的 273 个半球中，143 个（52%）为 D，130 个（48%）为 C。在 C 半球中，DBS 导联的放置误差（平均值±标准误差）为 0.88±0.07mm。在 D 半球中，MER 导致 DBS 导联显著迁移（平均 AT-DBS 误差 2.11±0.07mm），并且该距离明显大于 MER-O 和 DBS 之间的距离（2.11 与 1.09mm，P<0.05）。方向评估显示，除了目标方向为前外侧时，D 半球中 DBS 导联按 MER-O 确定的方向迁移。
在 52%的半球中观察到放射学和神经生理学目标之间的不匹配，MER 导致 DBS 导联适当向适当的目标偏移。与 C 半球中的 DBS 导联放置误差相比，平均而言，偏差的实际值很小。
