Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Surgery, Division of Neurosurgery, University of British Columbia, Vancouver, Canada.
Neurosurgery. 2020 Apr 1;86(4):E387-E397. doi: 10.1093/neuros/nyz544.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a well-established surgical therapy for patients with Parkinson disease (PD).
To define the role of adjacent white matter stimulation in the effectiveness of STN-DBS.
We retrospectively evaluated 43 patients with PD who received bilateral STN-DBS. The volumes of activated tissue were analyzed to obtain significant stimulation clusters predictive of 4 clinical outcomes: improvements in bradykinesia, rigidity, tremor, and reduction of dopaminergic medication. Tractography of the nigrofugal and pallidofugal pathways was performed. The significant clusters were used to calculate the involvement of the nigrofugal and pallidofugal pathways and the STN.
The clusters predictive of rigidity and tremor improvement were dorsal to the STN with most of the clusters outside of the STN. These clusters preferentially involved the pallidofugal pathways. The cluster predictive of bradykinesia improvement was located in the central part of the STN with an extension outside of the STN. The cluster predictive of dopaminergic medication reduction was located ventrolateral and caudal to the STN. These clusters preferentially involved the nigrofugal pathways.
Improvements in rigidity and tremor mainly involved the pallidofugal pathways dorsal to the STN. Improvement in bradykinesia mainly involved the central part of the STN and the nigrofugal pathways ventrolateral to the STN. Maximal reduction in dopaminergic medication following STN-DBS was associated with an exclusive involvement of the nigrofugal pathways.
丘脑底核（STN）深部脑刺激（DBS）是一种治疗帕金森病（PD）患者的成熟手术疗法。
确定毗邻白质刺激在 STN-DBS 有效性中的作用。
我们回顾性评估了 43 名接受双侧 STN-DBS 的 PD 患者。分析激活组织的体积以获得 4 个临床结果的显著刺激簇：改善运动迟缓、僵硬、震颤和减少多巴胺能药物。进行黑质和苍白球传出通路的轨迹描记术。使用显著簇来计算黑质和苍白球传出通路以及 STN 的参与情况。
预测僵硬和震颤改善的簇位于 STN 的背侧，大部分簇位于 STN 之外。这些簇优先涉及苍白球传出通路。预测运动迟缓改善的簇位于 STN 的中央部分，向外延伸到 STN 之外。预测多巴胺能药物减少的簇位于 STN 的腹侧和尾侧。这些簇优先涉及黑质传出通路。
僵硬和震颤的改善主要涉及 STN 背侧的苍白球传出通路。运动迟缓的改善主要涉及 STN 的中央部分和 STN 腹外侧的黑质传出通路。STN-DBS 后多巴胺能药物的最大减少与黑质传出通路的独家参与有关。
