Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA.
Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA,
Stereotact Funct Neurosurg. 2023;101(2):112-134. doi: 10.1159/000529040. Epub 2023 Feb 21.
Deep brain stimulation has become an established technology for the treatment of patients with a wide variety of conditions, including movement disorders, psychiatric disorders, epilepsy, and pain. Surgery for implantation of DBS devices has enhanced our understanding of human physiology, which in turn has led to advances in DBS technology. Our group has previously published on these advances, proposed future developments, and examined evolving indications for DBS.
The crucial roles of structural MR imaging pre-, intra-, and post-DBS procedure in target visualization and confirmation of targeting are described, with discussion of new MR sequences and higher field strength MRI enabling direct visualization of brain targets. The incorporation of functional and connectivity imaging in procedural workup and their contribution to anatomical modelling is reviewed. Various tools for targeting and implanting electrodes, including frame-based, frameless, and robot-assisted, are surveyed, and their pros and cons are described. Updates on brain atlases and various software used for planning target coordinates and trajectories are presented. The pros and cons of asleep versus awake surgery are discussed. The role and value of microelectrode recording and local field potentials are described, as well as the role of intraoperative stimulation. Technical aspects of novel electrode designs and implantable pulse generators are presented and compared.
脑深部刺激已成为治疗多种疾病的成熟技术，包括运动障碍、精神障碍、癫痫和疼痛。植入 DBS 设备的手术增强了我们对人体生理学的理解，这反过来又推动了 DBS 技术的发展。我们的团队之前已经发表了关于这些进展的文章，提出了未来的发展方向，并研究了 DBS 的不断发展的适应症。
本文描述了结构磁共振成像在 DBS 术前、术中和术后在目标可视化和确认定位中的关键作用，并讨论了新的磁共振序列和更高场强 MRI 能够直接可视化脑目标。还回顾了功能和连接成像在程序准备中的应用及其对解剖建模的贡献。调查了各种用于靶向和植入电极的工具，包括基于框架、无框架和机器人辅助，描述了它们的优缺点。介绍了脑图谱和用于规划目标坐标和轨迹的各种软件的更新。讨论了清醒与睡眠手术的优缺点。描述了微电极记录和局部场电位的作用和价值，以及术中刺激的作用。介绍并比较了新型电极设计和可植入脉冲发生器的技术方面。
