Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
Università degli Studi di Milano, Milan, Italy.
Sci Rep. 2023 Jun 8;13(1):9324. doi: 10.1038/s41598-023-30289-5.
Although only recently directional leads have proven their potential to compensate for sub-optimally placed electrodes, optimal lead positioning remains the most critical factor in determining Deep Brain Stimulation (DBS) outcome. Pneumocephalus is a recognized source of error, but the factors that contribute to its formation are still a matter of debate. Among these, operative time is one of the most controversial. Because cases of DBS performed with Microelectrode Recordings (MER) are affected by an increase in surgical length, it is useful to analyze whether MER places patients at risk for increased intracranial air entry. Data of 94 patients from two different institutes who underwent DBS for different neurologic and psychiatric conditions were analyzed for the presence of postoperative pneumocephalus. Operative time and use of MER, as well as other potential risk factors for pneumocephalus (age, awake vs. asleep surgery, number of MER passages, burr hole size, target and unilateral vs. bilateral implants) were examined. Mann-Whitney U and Kruskal-Wallis tests were utilized to compare intracranial air distributions across groups of categorical variables. Partial correlations were used to assess the association between time and volume. A generalized linear model was created to predict the effects of time and MER on the volume of intracranial air, controlling for other potential risk factors identified: age, number of MER passages, awake vs. asleep surgery, burr hole size, target, unilateral vs. bilateral surgery. Significantly different distributions of air volume were noted between different targets, unilateral vs. bilateral implants, and number of MER trajectories. Patients undergoing DBS with MER did not present a significant increase in pneumocephalus compared to patients operated without (p = 0.067). No significant correlation was found between pneumocephalus and time. Using multivariate analysis, unilateral implants exhibited lower volumes of pneumocephalus (p = 0.002). Two specific targets exhibited significantly different volumes of pneumocephalus: the bed nucleus of the stria terminalis with lower volumes (p < 0.001) and the posterior hypothalamus with higher volumes (p = 0.011). MER, time, and other parameters analyzed failed to reach statistical significance. Operative time and use of intraoperative MER are not significant predictors of pneumocephalus during DBS. Air entry is greater for bilateral surgeries and may be also influenced by the specific stimulated target.
尽管最近定向导联已被证明具有补偿电极位置不理想的潜力，但最佳导联定位仍然是决定深部脑刺激 (DBS) 效果的最关键因素。气颅是公认的误差源，但导致其形成的因素仍存在争议。其中，手术时间是最具争议的因素之一。由于使用微电极记录 (MER) 进行的 DBS 病例会增加手术时间，因此有必要分析 MER 是否会使患者面临颅内空气进入增加的风险。对来自两个不同机构的 94 名因不同神经和精神疾病接受 DBS 治疗的患者的数据进行了分析，以确定术后是否存在气颅。检查了手术时间和 MER 的使用情况，以及气颅的其他潜在危险因素（年龄、清醒与睡眠手术、MER 通道数、骨孔大小、目标以及单侧与双侧植入物）。使用 Mann-Whitney U 和 Kruskal-Wallis 检验比较了分类变量组之间的颅内空气分布。使用偏相关评估时间与体积之间的相关性。创建了广义线性模型来预测时间和 MER 对颅内空气体积的影响，同时控制了其他潜在的危险因素，包括年龄、MER 通道数、清醒与睡眠手术、骨孔大小、目标、单侧与双侧手术。不同的目标、单侧与双侧植入物以及 MER 轨迹之间的空气体积分布存在显著差异。与未接受 MER 手术的患者相比，接受 MER 手术的患者气颅发生率没有显著增加（p = 0.067）。未发现气颅与时间之间存在显著相关性。使用多元分析，单侧植入物显示出较低的气颅体积（p = 0.002）。两个特定的目标显示出显著不同的气颅体积：终纹床核的体积较小（p < 0.001），后下丘脑的体积较大（p = 0.011）。MER、时间和其他分析参数均未达到统计学意义。手术时间和术中使用 MER 不是 DBS 期间气颅的显著预测因素。双侧手术的空气进入量更大，并且可能还受到特定刺激目标的影响。
