Pinckard-Dover Heather, Al-Hindi Hytham, Goode Grace, Scott Hayden, Petersen Erika
Department of Neurosurgery, University of Florida, Gainesville, Florida, United States.
Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States.
Surg Neurol Int. 2021 Mar 2;12:82. doi: 10.25259/SNI_763_2020. eCollection 2021.
Various techniques are used across institutions for implantation of deep brain stimulation (DBS) leads. The most used techniques for each step include preoperative MRI fused to in-frame CT, intraoperative fluoroscopy, and postoperative CT, but postimplantation MRI also is used, as it was at our center. We present the quality assurance study performed at our institution after a change from postimplantation MRI performed across the hospital to postimplantation in room CT.
Retrospective chart review of 123 patients who underwent bilateral DBS leads placement without same-day generator placement that was performed. The patients were divided by the type of postoperative imaging that was obtained. Patients were excluded if a unilateral lead placement was performed, if the case was a revision of an existing lead or deviated from the normal protocol. Operative room times and procedure times for each group were analyzed with Wilcoxon rank sums test (WRST) to determine any significant differences between groups.
Postoperative MRI was performed for 82 patients, while postoperative CT was performed for 41 patients. A WRST showed a significant reduction in both operative room time (209 min to 170 min, < 0.0001) and procedure time (140 min to 126 min, = 0.0019).
In-room CT allowed for a significant reduction in operative room time. Lower operative room time has been associated with increased patient comfort, and decreased cost. CT did not alter the revision rate for procedures. The significant reduction in procedure time may be attributed to increased team familiarity with procedure over time.
不同机构在植入脑深部电刺激（DBS）电极时采用了多种技术。每个步骤最常用的技术包括术前将磁共振成像（MRI）与术中CT融合、术中荧光透视以及术后CT，但也会使用植入后MRI，我们中心就是如此。我们介绍了在我院进行的一项质量保证研究，该研究是在全院从植入后MRI改为植入后在手术室进行CT之后开展的。
对123例接受双侧DBS电极植入且未同期植入发生器的患者进行回顾性病历审查。根据所获得的术后成像类型对患者进行分组。如果是单侧电极植入、病例为现有电极的翻修或偏离正常方案，则将患者排除。使用Wilcoxon秩和检验（WRST）分析每组的手术室时间和手术时间，以确定两组之间是否存在显著差异。
82例患者进行了术后MRI，41例患者进行了术后CT。WRST显示手术室时间（从209分钟降至170分钟，P<0.0001）和手术时间（从140分钟降至126分钟，P = 0.0019）均显著缩短。
手术室CT可显著缩短手术室时间。较短的手术室时间与患者舒适度提高和成本降低相关。CT并未改变手术的翻修率。手术时间的显著缩短可能归因于随着时间推移团队对手术的熟悉程度提高。
