Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
Oper Neurosurg (Hagerstown). 2023 May 1;24(5):524-532. doi: 10.1227/ons.0000000000000582. Epub 2022 Dec 23.
Using electrocorticography for research (R-ECoG) during deep brain stimulation (DBS) surgery has advanced our understanding of human cortical-basal ganglia neurophysiology and mechanisms of therapeutic circuit modulation. The safety of R-ECoG has been established, but potential effects of temporary ECoG strip placement on targeting accuracy have not been reported.
To determine whether temporary subdural electrode strip placement during DBS implantation surgery affects lead implantation accuracy.
Twenty-four consecutive patients enrolled in a prospective database who underwent awake DBS surgery were identified. Ten of 24 subjects participated in R-ECoG. Lead locations were determined after fusing postoperative computed tomography scans into the surgical planning software. The effect of brain shift was quantified using Lead-DBS and analyzed in a mixed-effects model controlling for time interval to postoperative computed tomography. Targeting accuracy was reported as radial and Euclidean distance errors and compared with Mann-Whitney tests.
Neither radial error nor Euclidean distance error differed significantly between R-ECoG participants and nonparticipants. Pneumocephalus volume did not differ between the 2 groups, but brain shift was slightly greater with R-ECoG. Pneumocephalus volume correlated with brain shift, but neither of these measures significantly correlated with Euclidean distance error. There were no complications in either group.
In addition to an excellent general safety profile as has been reported previously, these results suggest that performing R-ECoG during DBS implantation surgery does not affect the accuracy of lead placement.
在深部脑刺激 (DBS) 手术中使用皮质电图 (ECoG) 进行研究 (R-ECoG) 已经提高了我们对人类皮质-基底节神经生理学和治疗回路调节机制的理解。R-ECoG 的安全性已经得到证实，但临时 ECoG 条放置对靶向准确性的潜在影响尚未报道。
确定在 DBS 植入手术期间临时放置硬膜下电极条是否会影响导联植入的准确性。
确定了 24 名连续纳入前瞻性数据库并接受清醒 DBS 手术的患者。24 名患者中有 10 名参与了 R-ECoG。将术后 CT 扫描融合到手术计划软件中后确定导联位置。使用 Lead-DBS 量化脑移位的影响，并在混合效应模型中进行分析，控制到术后 CT 的时间间隔。报告靶向准确性作为径向和欧几里得距离误差，并通过 Mann-Whitney 检验进行比较。
R-ECoG 参与者和非参与者之间的径向误差或欧几里得距离误差均无显著差异。两组的气颅体积没有差异，但 R-ECoG 组的脑移位稍大。气颅体积与脑移位相关，但两者均与欧几里得距离误差无显著相关性。两组均无并发症。
除了先前报道的良好的一般安全性概况外，这些结果表明，在 DBS 植入手术期间进行 R-ECoG 不会影响导联放置的准确性。
