Department of Neurosurgery, Centro Hospitalar e Universitário de São João, Porto, Portugal; Department of Clinical Neurosciences, Faculty of Medicine, University of Porto, Portugal; Movement Disorders and Functional Neurosurgery Unit, Centro Hospitalar e Universitário de São João, Porto, Portugal.
Department of Clinical Neurosciences, Faculty of Medicine, University of Porto, Portugal; Movement Disorders and Functional Neurosurgery Unit, Centro Hospitalar e Universitário de São João, Porto, Portugal; Department of Neurology, Centro Hospitalar e Universitário de São João, Porto, Portugal.
Neurocirugia (Astur : Engl Ed). 2023 Jul-Aug;34(4):186-193. doi: 10.1016/j.neucie.2022.07.001. Epub 2023 Feb 10.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a recognized treatment for drug-refractory Parkinson's disease (PD). However, the therapeutic success depends on the accuracy of targeting. This study aimed to evaluate potential accuracy differences in the placement of the first and second electrodes implanted, by comparing chosen electrode trajectories, STN activity detected during microelectrode recording (MER), and the mismatch between the initially planned and final electrode positions on each side.
In this retrospective cohort study, we analyzed data from 30 patients who underwent one-stage bilateral DBS. For most patients, three arrays of microelectrodes were used to determine the physiological location of the STN. Final target location depended also on the results of intraoperative stimulation. The choice of central versus non-central channels was compared. The Euclidean vector deviation was calculated using the initially planned coordinates and the final position of the tip of the electrode according to a CT scan taken at least a month after the surgery.
The central channel was chosen in 70% of cases on the first side and 40% of cases on the second side. The mean length of high-quality STN activity recorded in the central channel was longer on the first side than the second (3.07±1.85mm vs. 2.75±1.94mm), while in the anterior channel there were better MER recordings on the second side (1.59±2.07mm on the first side vs. 2.78±2.14mm on the second). Regarding the mismatch between planned versus final electrode position, electrodes on the first side were placed on average 0.178±0.917mm lateral, 0.126±1.10mm posterior and 1.48±1.64mm inferior to the planned target, while the electrodes placed on the second side were 0.251±1.08mm medial, 0.355±1.29mm anterior and 2.26±1.47mm inferior to the planned target.
There was a tendency for the anterior trajectory to be chosen more frequently than the central on the second side. There was also a statistically significant deviation of the second electrodes in the anterior and inferior directions, when compared to the electrodes on the first side, suggesting that another cause other than brain shift may be responsible. We should therefore factor this during planning for the second implanted side. It might be useful to plan the second side more anteriorly, possibly reducing the number of MER trajectories tested and the duration of surgery.
深部脑刺激（DBS）的丘脑底核（STN）是一种公认的治疗药物难治性帕金森病（PD）的方法。然而，治疗的成功取决于靶向的准确性。本研究旨在通过比较选定的电极轨迹、微电极记录（MER）期间检测到的 STN 活动以及每侧最初计划和最终电极位置之间的不匹配，评估第一次和第二次植入电极位置的潜在准确性差异。
在这项回顾性队列研究中，我们分析了 30 名接受一期双侧 DBS 的患者的数据。对于大多数患者，使用三个微电极阵列来确定 STN 的生理位置。最终目标位置还取决于术中刺激的结果。比较了中央通道与非中央通道的选择。使用根据手术后至少一个月拍摄的 CT 扫描计算初始计划坐标和电极尖端的最终位置的欧几里得向量偏差。
第一次侧中央通道选择在 70%的病例中，第二次侧中央通道选择在 40%的病例中。在中央通道中记录到的高质量 STN 活动的平均长度在第一次侧比第二次侧长（3.07±1.85mm 比 2.75±1.94mm），而在前通道中第二次侧的 MER 记录更好（第一次侧 1.59±2.07mm 比第二次侧 2.78±2.14mm）。关于计划与最终电极位置之间的不匹配，第一次侧的电极平均放置在计划靶标外侧 0.178±0.917mm、后侧 0.126±1.10mm 和下方 1.48±1.64mm，而第二次侧的电极放置在计划靶标内侧 0.251±1.08mm、前侧 0.355±1.29mm 和下方 2.26±1.47mm。
在第二次侧，前轨迹的选择频率比中央轨迹高。与第一次侧的电极相比，第二次侧的电极在前后和下方向上的偏差也具有统计学意义，这表明可能还有其他原因，而不仅仅是脑移位。因此，我们应该在为第二次植入侧进行规划时考虑到这一点。更靠前地规划第二次侧可能会有用，可能会减少测试 MER 轨迹的数量和手术时间。
