Neurosurgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
Neurology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
J Neurol Neurosurg Psychiatry. 2023 Mar;94(3):236-244. doi: 10.1136/jnnp-2022-329192. Epub 2022 Oct 7.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective neurosurgical treatment for Parkinson's disease. Surgical accuracy is a critical determinant to achieve an adequate DBS effect on motor performance. A two-millimetre surgical accuracy is commonly accepted, but scientific evidence is lacking. A systematic review and meta-analysis of study-level and individual patient data (IPD) was performed by a comprehensive search in MEDLINE, EMBASE and Cochrane Library. Primary outcome measures were (1) radial error between the implanted electrode and target; (2) DBS motor improvement on the Unified Parkinson's Disease Rating Scale part III (motor examination). On a study level, meta-regression analysis was performed. Also, publication bias was assessed. For IPD meta-analysis, a linear mixed effects model was used. Forty studies (1391 patients) were included, reporting radial errors of 0.45-1.86 mm. Errors within this range did not significantly influence the DBS effect on motor improvement. Additional IPD analysis (206 patients) revealed that a mean radial error of 1.13±0.75 mm did not significantly change the extent of DBS motor improvement. Our meta-analysis showed a huge publication bias on accuracy data in DBS. Therefore, the current literature does not provide an unequivocal upper threshold for acceptable accuracy of STN-DBS surgery. Based on the current literature, DBS-electrodes placed within a 2 mm range of the intended target do not have to be repositioned to enhance motor improvement after STN-DBS for Parkinson's disease. However, an indisputable upper cut-off value for surgical accuracy remains to be established. PROSPERO registration number is CRD42018089539.
深部脑刺激（DBS）丘脑底核（STN）是治疗帕金森病的有效神经外科治疗方法。手术的准确性是实现对运动表现的充分 DBS 效果的关键决定因素。通常接受 2 毫米的手术精度，但缺乏科学证据。通过全面搜索 MEDLINE、EMBASE 和 Cochrane Library，对研究水平和个体患者数据（IPD）进行了系统评价和荟萃分析。主要结果测量指标为：（1）植入电极和目标之间的径向误差；（2）统一帕金森病评定量表第三部分（运动检查）上的 DBS 运动改善。在研究水平上，进行了元回归分析。还评估了出版偏倚。对于 IPD 荟萃分析，使用了线性混合效应模型。共有 40 项研究（1391 名患者）报告了 0.45-1.86mm 的径向误差。在此范围内的误差不会显著影响 DBS 对运动改善的效果。额外的 IPD 分析（206 名患者）表明，平均径向误差为 1.13±0.75mm 不会显著改变 DBS 运动改善的程度。我们的荟萃分析显示，DBS 准确性数据存在巨大的出版偏倚。因此，目前的文献并没有为 STN-DBS 手术的可接受精度提供明确的上限阈值。基于目前的文献，DBS 电极放置在预期目标的 2mm 范围内，不一定需要重新定位以增强 STN-DBS 治疗帕金森病后的运动改善。然而，手术准确性的无可争议的上限值仍有待确定。PROSPERO 注册号为 CRD42018089539。
