Department of Neurosurgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang Province, China.
Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang Province, China.
J Parkinsons Dis. 2022;12(3):897-903. doi: 10.3233/JPD-213095.
Accurate electrode targeting was essential for the efficacy of deep brain stimulation (DBS). There is ongoing debate about the necessary of microelectrode recording (MER) in subthalamic nucleus (STN)-DBS surgery for accurate targeting.
This study aimed to analyze the accuracy of imaging-guided awake DBS with MER in STN for Parkinson's disease in a single center.
The authors performed a retrospective analysis of 161 Parkinson's disease patients undergoing STN-DBS at our center from March 2013 to June 2021. The implantation was performed by preoperative magnetic resonance imaging (MRI)-based direct targeting with intraoperative MER and macrostimulation testing. 285 electrode tracks with preoperative and postoperative coordinates were included to calculate the placement error in STN targeting.
85.9% of electrodes guided by preoperative MRI were implanted without intraoperative adjustment. 31 (10.2%) and 12 (3.9%) electrodes underwent intraoperative adjustment due to MER and intraoperative testing, respectively. We found 86.2% (245/285) of electrodes with trajectory error ≤2 mm. The MER physiological signals length < 4 mm and ≥4 mm group showed trajectory error > 2 mm in 38.0% and 8.8% of electrodes, respectively. Compared to non-adjustment electrodes, the final positioning of MER-adjusted electrodes deviated from the center of STN.
The preoperative MRI guided STN targeting results in approximately 14% cases that require electrode repositioning. MER physiological signals length < 4 mm at first penetration implied deviation off planned target. MER combined with intraoperative awake testing served to rescue such deviation based on MRI alone.
准确的电极定位对于深部脑刺激（DBS）的疗效至关重要。对于准确的靶点定位，在丘脑底核（STN）-DBS 手术中是否需要微电极记录（MER）仍存在争议。
本研究旨在分析单中心 STN 内使用 MER 进行成像引导清醒 DBS 治疗帕金森病的准确性。
作者对 2013 年 3 月至 2021 年 6 月在我院接受 STN-DBS 的 161 例帕金森病患者进行了回顾性分析。植入术采用术前基于磁共振成像（MRI）的直接靶向定位，术中结合 MER 和宏观刺激测试。共纳入 285 条术前和术后电极轨迹，以计算 STN 靶向定位的放置误差。
85.9%的术前 MRI 引导电极无需术中调整即可植入。由于 MER 和术中测试，分别有 31（10.2%）和 12（3.9%）根电极需要术中调整。我们发现 86.2%（245/285）的电极轨迹误差≤2mm。MER 生理信号长度<4mm 和≥4mm 组电极轨迹误差>2mm 的比例分别为 38.0%和 8.8%。与未调整电极相比，MER 调整电极的最终定位偏离了 STN 中心。
术前 MRI 引导的 STN 靶向定位结果约有 14%的病例需要重新定位电极。首次穿透时 MER 生理信号长度<4mm 意味着偏离了预定目标。MER 结合术中清醒测试可根据 MRI 单独对这种偏差进行矫正。
