全身麻醉下丘脑底核深部脑刺激治疗帕金森病：机构经验与结果
Subthalamic Deep Brain Stimulation under General Anaesthesia for Parkinson's Disease: Institutional Experience and Outcomes.
作者信息
Roldán Pedro, Mosteiro Alejandra, Rumià Arboix Jordi, Asín Daniel, Sánchez-Gómez Almudena, Valldeoriola Francesc, García-Orellana Marta, de Riva Nicolás, Valero Ricard
机构信息
Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain.
Faculty of Medicine, University of Barcelona, Barcelona, Spain.
出版信息
Stereotact Funct Neurosurg. 2025;103(2):102-110. doi: 10.1159/000542791. Epub 2024 Nov 27.
INTRODUCTION
Direct targeting in deep brain stimulation (DBS) has remarkably impacted the patient's experience throughout the surgery and the overall logistics of the procedure. When the individualised plan is co-registered with a 3D image acquired intraoperatively, the electrodes can be safely placed under general anaesthesia. How this applies to a general practice scenery (outside clinical trials and in a moderate caseload centre) has been scarcely reported.
METHODS
Prospective single-centre study of patients treated with asleep subthalamic DBS for Parkinson's disease between January 2021 and December 2022. Clinical, motor, medication-dependence, and quality-of-life outcomes were evaluated after optimal programming (6 months). Wilcoxon test was used to compare pre- versus post-repeated measures. Surgical-related parameters were also analysed.
RESULTS
Eighty-nine patients primarily operated for DBS were included in the study. Intraoperative electrode replacement was not necessary. Mean surgical duration was 217 (SD 44) minutes, including the implantation of the generator; and mean length of stay was 3 (SD 1) days. There was one surgical-related complication (delayed infection). Significant and clinically relevant improvement was seen in UPRS III (mean decrease 62%) (p < 0.001) and PDQ-8 (50% increase) (p < 0.001) after 6 months. Daily doses of medication were decreased by a mean of 68%, p < 0.001).
CONCLUSION
DBS can be safely performed under general anaesthesia in a pragmatic clinical environment, provided a multidisciplinary committee for patient selection and a dedicated surgical and anaesthetic team are available. The effectiveness in ameliorating motor symptoms, the ability to reduce the drug load, and the improvement in quality of life demonstrated in clinical trials could be reproduced under more generalised conditions as in our centre. The need for a team learning curve and the progressive evolution in, and adaptation to, trajectory planning software, anaesthetic management, intraoperative imaging, DBS device upgrades, and programming schemes should be contemplated in the transition process to direct targeting.
INTRODUCTION
Direct targeting in deep brain stimulation (DBS) has remarkably impacted the patient's experience throughout the surgery and the overall logistics of the procedure. When the individualised plan is co-registered with a 3D image acquired intraoperatively, the electrodes can be safely placed under general anaesthesia. How this applies to a general practice scenery (outside clinical trials and in a moderate caseload centre) has been scarcely reported.
METHODS
Prospective single-centre study of patients treated with asleep subthalamic DBS for Parkinson's disease between January 2021 and December 2022. Clinical, motor, medication-dependence, and quality-of-life outcomes were evaluated after optimal programming (6 months). Wilcoxon test was used to compare pre- versus post-repeated measures. Surgical-related parameters were also analysed.
RESULTS
Eighty-nine patients primarily operated for DBS were included in the study. Intraoperative electrode replacement was not necessary. Mean surgical duration was 217 (SD 44) minutes, including the implantation of the generator; and mean length of stay was 3 (SD 1) days. There was one surgical-related complication (delayed infection). Significant and clinically relevant improvement was seen in UPRS III (mean decrease 62%) (p < 0.001) and PDQ-8 (50% increase) (p < 0.001) after 6 months. Daily doses of medication were decreased by a mean of 68%, p < 0.001).
CONCLUSION
DBS can be safely performed under general anaesthesia in a pragmatic clinical environment, provided a multidisciplinary committee for patient selection and a dedicated surgical and anaesthetic team are available. The effectiveness in ameliorating motor symptoms, the ability to reduce the drug load, and the improvement in quality of life demonstrated in clinical trials could be reproduced under more generalised conditions as in our centre. The need for a team learning curve and the progressive evolution in, and adaptation to, trajectory planning software, anaesthetic management, intraoperative imaging, DBS device upgrades, and programming schemes should be contemplated in the transition process to direct targeting.
引言
在脑深部电刺激（DBS）中，直接靶向显著影响了患者在整个手术过程中的体验以及手术的整体流程。当个体化计划与术中获取的三维图像共同配准后，电极可在全身麻醉下安全放置。然而，关于这在普通临床实践场景（非临床试验且病例数量适中的中心）中的应用情况，鲜有报道。
方法
对2021年1月至2022年12月期间接受丘脑底核睡眠状态下DBS治疗帕金森病的患者进行前瞻性单中心研究。在优化程控（6个月）后评估临床、运动、药物依赖及生活质量结局。采用Wilcoxon检验比较重复测量的术前与术后情况。还分析了手术相关参数。
结果
本研究纳入了89例主要接受DBS手术的患者。术中无需更换电极。平均手术时长为217（标准差44）分钟，包括植入发生器；平均住院时长为3（标准差1）天。发生了1例与手术相关的并发症（延迟感染）。6个月后UPRS III评分有显著且具有临床意义的改善（平均降低62%）（p<0.001），PDQ - 8评分提高了50%（p<0.001）。每日药物剂量平均降低了68%，p<0.001。
结论
在务实的临床环境中，若有用于患者选择的多学科委员会以及专业的手术和麻醉团队，DBS可在全身麻醉下安全进行。临床试验中所证明的改善运动症状的有效性、降低药物负荷的能力以及生活质量的提高，在我们中心这样更普遍的条件下也能够重现。在向直接靶向过渡的过程中，应考虑团队学习曲线的需求以及轨迹规划软件、麻醉管理、术中成像、DBS设备升级和程控方案的逐步发展与适应情况。
引言
在脑深部电刺激（DBS）中，直接靶向显著影响了患者在整个手术过程中的体验以及手术的整体流程。当个体化计划与术中获取的三维图像共同配准后，电极可在全身麻醉下安全放置。然而，关于这在普通临床实践场景（非临床试验且病例数量适中的中心）中的应用情况，鲜有报道。
方法
对2021年1月至2022年12月期间接受丘脑底核睡眠状态下DBS治疗帕金森病的患者进行前瞻性单中心研究。在优化程控（6个月）后评估临床、运动、药物依赖及生活质量结局。采用Wilcoxon检验比较重复测量的术前与术后情况。还分析了手术相关参数。
结果
本研究纳入了89例主要接受DBS手术的患者。术中无需更换电极。平均手术时长为217（标准差44）分钟，包括植入发生器；平均住院时长为3（标准差1）天。发生了1例与手术相关的并发症（延迟感染）。6个月后UPRS III评分有显著且具有临床意义的改善（平均降低62%）（p<0.001），PDQ - 8评分提高了50%（p<0.001）。每日药物剂量平均降低了68%，p<0.001。
结论
在务实的临床环境中，若有用于患者选择的多学科委员会以及专业的手术和麻醉团队，DBS可在全身麻醉下安全进行。临床试验中所证明的改善运动症状的有效性、降低药物负荷的能力以及生活质量的提高，在我们中心这样更普遍的条件下也能够重现。在向直接靶向过渡的过程中，应考虑团队学习曲线的需求以及轨迹规划软件、麻醉管理、术中成像、DBS设备升级和程控方案的逐步发展与适应情况。
Zotero 插件