Holland Marshall T, Jiao Jocelyn, Mantovani Alessandra, Anderson Shannon, Mitchell Katherine A, Safarpour Delaram, Burchiel Kim J
1Department of Neurological Surgery, University of Alabama at Birmingham, Alabama; and.
2Department of Neurology and.
J Neurosurg. 2022 Jul 22;138(2):329-336. doi: 10.3171/2022.5.JNS22152. Print 2023 Feb 1.
The globus pallidus internus (GPI) has been demonstrated to be an effective surgical target for deep brain stimulation (DBS) treatment in patients with medication-refractory Parkinson's disease (PD). The ability of neurosurgeons to define the area of greatest therapeutic benefit within the globus pallidus (GP) may improve clinical outcomes in these patients. The objective of this study was to determine the best DBS therapeutic implantation site within the GP for effective treatment in PD patients.
The authors performed a retrospective review of 56 patients who underwent bilateral GP DBS implantation at their institution during the period from January 2015 to January 2020. Each implanted contact was anatomically localized. Patients were followed for stimulation programming for at least 6 months. The authors reviewed preoperative and 6-month postsurgery clinical outcomes based on data from the Unified Parkinson's Disease Rating Scale Part III (UPDRS III), dyskinesia scores, and levodopa equivalent daily dose (LEDD).
Of the 112 leads implanted, the therapeutic cathode was most frequently located in the lamina between the GPI external segment (GPIe) and the GP externus (GPE) (n = 40). Other common locations included the GPE (n = 24), the GPIe (n = 15), and the lamina between the GPI internal segment (GPIi) and the GPIe (n = 14). In the majority of patients (73%) a monopolar programming configuration was used. At 6 months postsurgery, UPDRS III off medications (OFF) and on stimulation (ON) scores significantly improved (z = -4.02, p < 0.001), as did postsurgery dyskinesia ON scores (z = -4.08, p < 0.001) and postsurgery LEDD (z = -4.7, p < 0.001).
Though the ventral GP (pallidotomy target) has been a commonly used target for GP DBS, a more dorsolateral target may be more effective for neuromodulation strategies. The assessment of therapeutic contact locations performed in this study showed that the lamina between GPI and GPE used in most patients is the optimal central stimulation target. This information should improve preoperative GP targeting.
苍白球内侧部（GPI）已被证明是药物难治性帕金森病（PD）患者深部脑刺激（DBS）治疗的有效手术靶点。神经外科医生确定苍白球（GP）内最大治疗获益区域的能力可能会改善这些患者的临床结局。本研究的目的是确定GP内最佳的DBS治疗植入部位，以有效治疗PD患者。
作者对2015年1月至2020年1月期间在其机构接受双侧GP DBS植入的56例患者进行了回顾性研究。对每个植入电极进行解剖定位。对患者进行至少6个月的刺激程控随访。作者根据统一帕金森病评定量表第三部分（UPDRS III）、异动症评分和左旋多巴等效日剂量（LEDD）的数据回顾了术前和术后6个月的临床结局。
在植入的112根电极中，治疗阴极最常位于GPI外侧段（GPIe）和苍白球外侧部（GPE）之间的层面（n = 40）。其他常见位置包括GPE（n = 24）、GPIe（n = 15）以及GPI内侧段（GPIi）和GPIe之间的层面（n = 14）。大多数患者（73%）采用单极程控配置。术后6个月，停用药物（OFF）和开启刺激（ON）时的UPDRS III评分显著改善（z = -4.02，p < 0.001），术后异动症ON评分（z = -4.08，p < 0.001）和术后LEDD（z = -4.7，p < 0.001）也显著改善。
虽然腹侧GP（苍白球切开术靶点）一直是GP DBS常用的靶点，但更靠背外侧的靶点可能对神经调节策略更有效。本研究中对治疗电极位置的评估表明，大多数患者使用的GPI和GPE之间的层面是最佳的中央刺激靶点。该信息应能改善术前GP靶点定位。
