Holanda Vanessa M, Eisinger Robert Stephen, Almeida Leonardo, Tsuboi Takashi, Wang Huimin, Okun Michael S, Deeb Wissam, Patterson Addie, Wagle Shukla Aparna, Lobo Lopes Janine, Foote Kelly Douglas
Department of Neurosurgery, Center of Neurology and Neurosurgery Associates (NeuroCENNA), Beneficencia Portuguesa of São Paulo Hospital, São Paulo, Brazil.
Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States.
Front Neurol. 2021 Aug 12;12:679918. doi: 10.3389/fneur.2021.679918. eCollection 2021.
The aim of this study is to evaluate the evolution of GPi DBS targeting. This retrospective, single-center study included patients implanted with GPi DBS leads for dystonia or PD during the years 2004 to 2018 at the University of Florida Fixel Institute for Neurological Diseases. Each patient underwent a high-resolution targeting study on the day prior to the surgery, which was fused with a high resolution CT scan that was acquired on the day of the procedure. Intraoperative target location was selected using a digitized 3D Schaltenbrand-Bailey atlas. All patients underwent a high-resolution head CT scan without contrast approximately one month after lead implantation and accurate measurement of neuroanatomical lead position was acquired after fusion of pre-operative and post-operative image studies. We analyzed 253 PD patients with 352 leads and 80 dystonia patients with 141 leads. During 15 years of follow-up, lead locations in the PD group migrated more laterally (β = 0.09, < 0.0001), posteriorly [slope (β) = 0.04, < 0.05], and dorsally (β = 0.07, < 0.001), whereas leads in the dystonia group did not significantly change position aside from a trend in the dorsal direction (β = 0.06, = 0.053). The evolving target likely results from multiple factors including improvements in targeting techniques and clinical feedback intraoperatively and post-operatively. Our demonstrates the potential importance of a systematic post-operative DBS lead measurement protocol to ensure quality control and to inform and optimize DBS programming.
本研究的目的是评估苍白球内侧部（GPi）脑深部电刺激（DBS）靶点定位的演变情况。这项回顾性单中心研究纳入了2004年至2018年期间在佛罗里达大学菲克塞尔神经疾病研究所因肌张力障碍或帕金森病（PD）而植入GPi DBS电极的患者。每位患者在手术前一天接受了高分辨率靶点定位研究，并与手术当天获取的高分辨率CT扫描图像进行融合。术中靶点位置采用数字化的3D Schaltenbrand-Bailey图谱进行选择。所有患者在电极植入后约1个月接受了无造影剂的高分辨率头部CT扫描，并在术前和术后图像研究融合后获得神经解剖学电极位置的精确测量值。我们分析了253例植入352根电极的PD患者和80例植入141根电极的肌张力障碍患者。在15年的随访期间，PD组的电极位置向外侧（β = 0.09，P < 0.0001）、后方[斜率（β） = 0.04，P < 0.05]和背侧（β = 0.07，P < 0.001）迁移，而肌张力障碍组的电极位置除了有背侧方向的趋势外（β = 0.06，P = 0.053）没有显著变化。靶点位置的演变可能是由多种因素导致的，包括靶点定位技术的改进以及术中及术后的临床反馈。我们的研究表明了系统性术后DBS电极测量方案对于确保质量控制以及为DBS程控提供信息和优化的潜在重要性。
