Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center for Parkinson's Disease, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
World Neurosurg. 2021 Oct;154:e1-e6. doi: 10.1016/j.wneu.2021.03.026. Epub 2021 Mar 17.
Microelectrode recording (MER)-guided deep brain stimulation (DBS) remains the standard electrophysiological procedure to place the DBS lead at the optimal target. When single-track MER or test stimulation yields suboptimal results, trajectory adjustments are needed. Intraoperative computed tomography (iCT) can be useful to visualize the microelectrode and verify possible adjustments. The aim of this study was to evaluate the effect of iCT in MER during frameless stereotactic DBS for Parkinson disease (PD).
We retrospectively collected 28 PD patients, of whom 19 received iCT and 9 did not, and measured intracranial volume, cerebral volume, cerebrospinal fluid volume, and pneumocephalus volume. Euclidean distance was assessed according to merged preoperative brain CT and magnetic resonance imaging and postoperative brain CT.
Fifty-six hemispheres in the 28 patients were analyzed for MER tracks. The patients who received iCT had a significantly lower mean number of MER tracks (1.6 vs. 2.6, P = 0.013) and lower mean Euclidean distance (2.2 mm vs. 2.7 mm, P = 0.033) compared with those who did not receive iCT. Although there was a trend of a decrease in pneumocephalus using intraoperative imaging, there was no significant difference in surgical time.
iCT can reduce the number of MER tracks and increase surgical accuracy. Further studies are warranted to investigate whether iCT can reduce surgical complications and improve surgical outcomes.
微电极记录（MER）引导的深部脑刺激（DBS）仍然是将 DBS 导联放置在最佳目标位置的标准电生理学程序。当单轨迹 MER 或测试刺激产生不理想的结果时，需要进行轨迹调整。术中计算机断层扫描（iCT）可用于可视化微电极并验证可能的调整。本研究旨在评估 iCT 在无框架立体定向 DBS 治疗帕金森病（PD）中的 MER 中的作用。
我们回顾性收集了 28 例 PD 患者，其中 19 例行 iCT，9 例行非 iCT，并测量了颅内体积、脑体积、脑脊液体积和气颅体积。根据术前脑 CT 和磁共振成像与术后脑 CT 合并测量欧几里得距离。
对 28 例患者的 56 个半脑进行了 MER 轨迹分析。与未行 iCT 的患者相比，行 iCT 的患者 MER 轨迹的平均数量明显较少（1.6 对 2.6，P=0.013），平均欧几里得距离也较短（2.2 毫米对 2.7 毫米，P=0.033）。尽管术中成像有减少气颅的趋势，但手术时间无显著差异。
iCT 可减少 MER 轨迹的数量并提高手术准确性。需要进一步研究以调查 iCT 是否可以减少手术并发症并改善手术结果。
