Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Neurosurgery. 2021 Apr 15;88(5):E420-E426. doi: 10.1093/neuros/nyaa592.
Intraoperative research during deep brain stimulation (DBS) surgery has enabled major advances in understanding movement disorders pathophysiology and potential mechanisms for therapeutic benefit. In particular, over the last decade, recording electrocorticography (ECoG) from the cortical surface, simultaneously with subcortical recordings, has become an important research tool for assessing basal ganglia-thalamocortical circuit physiology.
To provide confirmation of the safety of performing ECoG during DBS surgery, using data from centers involved in 2 BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative-funded basic human neuroscience projects.
Data were collected separately at 4 centers. The primary endpoint was complication rate, defined as any intraoperative event, infection, or postoperative magnetic resonance imaging abnormality requiring clinical follow-up. Complication rates for explanatory variables were compared using point biserial correlations and Fisher exact tests.
A total of 367 DBS surgeries involving ECoG were reviewed. No cortical hemorrhages were observed. Seven complications occurred: 4 intraparenchymal hemorrhages and 3 infections (complication rate of 1.91%; CI = 0.77%-3.89%). The placement of 2 separate ECoG research electrodes through a single burr hole (84 cases) did not result in a significantly different rate of complications, compared to placement of a single electrode (3.6% vs 1.5%; P = .4). Research data were obtained successfully in 350 surgeries (95.4%).
Combined with the single report previously available, which described no ECoG-related complications in a single-center cohort of 200 cases, these findings suggest that research ECOG during DBS surgery did not significantly alter complication rates.
在脑深部刺激 (DBS) 手术过程中进行的术中研究使我们能够深入了解运动障碍的病理生理学和潜在的治疗获益机制。特别是在过去十年中，同时记录皮质表面的皮质脑电图 (ECoG) 和皮质下记录已成为评估基底节-丘脑皮质回路生理学的重要研究工具。
使用参与 2 个 BRAIN（通过推进创新性神经技术进行大脑研究）倡议资助的基础人类神经科学项目的中心的数据，为 DBS 手术期间进行 ECoG 提供安全性确认。
数据分别在 4 个中心收集。主要终点是并发症发生率，定义为任何术中事件、感染或需要临床随访的术后磁共振成像异常。使用点双列相关和 Fisher 确切检验比较解释变量的并发症发生率。
共回顾了 367 例涉及 ECoG 的 DBS 手术。未观察到皮质内出血。发生了 7 种并发症：4 例脑实质内出血和 3 例感染（并发症发生率为 1.91%；CI=0.77%-3.89%）。通过单个骨孔放置 2 个单独的 ECoG 研究电极（84 例）与放置单个电极（3.6%与 1.5%；P=0.4）相比，并没有导致并发症发生率显著不同。350 例手术（95.4%）成功获得了研究数据。
与之前单独报告的一项研究结果相结合，该研究报告了在 200 例单中心队列中没有 ECoG 相关并发症，这些发现表明在 DBS 手术过程中进行研究性 ECoG 并没有显著改变并发症发生率。
