Asriyants S V, Tomskiy A A, Gamaleya A A, Pronin I N
Burdenko Neurosurgical Center, Moscow, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 2021;85(5):117-121. doi: 10.17116/neiro202185051117.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is known to be an effective and safe neurosurgical procedure for Parkinson's disease (PD). Traditionally, awake implantation of stimulation system is carried out using microelectrode registration and intraoperative stimulation. Development of neuroimaging technologies enables direct STN imaging. Therefore, asleep surgery without additional intraoperative verification is possible. This approach reduces surgery time and can potentially decrease the incidence of hemorrhagic and infectious complications. The advantages of one method or another are being discussed.
To assess the benefits and limitations of various methods for DBS system implantation for bilateral STN stimulation, to study the issues of stereotaxic accuracy, efficiency and safety of asleep and awake electrode implantation into STN.
We reviewed the articles published in the PubMed database. Searching algorithm included the following keywords: «asleep DBS», «Parkinson's disease», «subthalamic nucleus», «3T MRI», «SWI», «SWAN».
There were 31 articles devoted to asleep DBS of STN including 4 meta-analyses, 3 prospective controlled studies, 13 retrospective controlled studies and 11 studies without a control group.
Asleep implantation of electrodes for DBS of STN can be performed only after a clear imaging of STN boundaries with high-quality MRI.
已知丘脑底核（STN）的深部脑刺激（DBS）是一种治疗帕金森病（PD）的有效且安全的神经外科手术。传统上，刺激系统的清醒植入是通过微电极记录和术中刺激来进行的。神经成像技术的发展使得直接对STN进行成像成为可能。因此，无需额外术中验证的睡眠状态下手术成为可能。这种方法减少了手术时间，并有可能降低出血和感染并发症的发生率。人们正在讨论这两种方法各自的优点。
评估双侧STN刺激的DBS系统植入的各种方法的益处和局限性，研究睡眠状态和清醒状态下将电极植入STN的立体定向准确性、效率和安全性问题。
我们回顾了发表在PubMed数据库中的文章。检索算法包括以下关键词：“睡眠状态下的DBS”、“帕金森病”、“丘脑底核”、“3T磁共振成像”、“磁敏感加权成像”、“相位对比血管造影”。
有31篇文章专门论述了STN的睡眠状态下DBS，其中包括4篇荟萃分析（meta分析）、3篇前瞻性对照研究、13篇回顾性对照研究和11篇无对照组的研究。
只有在通过高质量磁共振成像清晰显示STN边界后，才能进行睡眠状态下的STN-DBS电极植入。
