Ibrulj Sandro, Georgiev Dejan, Samsa Žiga, Mušič Polona, Benedičič Mitja, Trošt Maja
Department of Neurology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia.
Faculty of Computer Science and Informatics, University of Ljubljana, 1000 Ljubljana, Slovenia.
Clin Park Relat Disord. 2025 Jan 6;12:100299. doi: 10.1016/j.prdoa.2025.100299. eCollection 2025.
Intraoperative microelectrode recording (MER) and intraoperative test stimulation may provide vital information for optimal electrode placement and clinical outcome in movement disorders patients treated with deep brain stimulation (DBS). The aims of this retrospective study were to determine (i) how often the planned (imaging based) placements of electrodes were changed due to MER and intraoperative test stimulation in Parkinson's disease (PD), dystonia and essential tremor (ET) patients; (ii) whether the frequency of repositioning changed over time; (iii) whether patients' age or disease duration (in PD) influenced the frequency of repositioning.
Data on the planned and the final placement of 141 electrodes in 72 consecutive DBS treated patients (52 PD, 11 dystonia, 9 ET) was collected over the first 8 years of DBS implementation in a single center. An association between the rate of electrode repositioning and the patients' age, disease duration and the time/year of implementation was explored.
Analysis of all targets showed a change in final electrode placement in 39.7 % (56/141); 39.8 % (41/103) in PD, 40.9 % (9/22) in dystonia and 37.5 % (6/16) in ET. Annual analysis showed a decrease in rate of repositioning between the centre's first and eighth year (p = 0.013) of implementation. No correlation was found between electrode repositioning rate and patient age (p = 0.42) nor disease duration (p = 0.09) in PD.
This retrospective analysis confirms the benefit of MER and intraoperative test stimulation during DBS surgery in determining the final electrode position during the early / initial period of implementing the procedure. Our findings show a learning curve in successful preoperative planning in our centre achieved through experience.
术中微电极记录（MER）和术中测试刺激可为接受深部脑刺激（DBS）治疗的运动障碍患者的最佳电极放置和临床结果提供重要信息。这项回顾性研究的目的是确定：（i）在帕金森病（PD）、肌张力障碍和特发性震颤（ET）患者中，由于MER和术中测试刺激，计划（基于影像学）的电极放置改变的频率；（ii）重新定位的频率是否随时间变化；（iii）患者年龄或疾病持续时间（在PD中）是否影响重新定位的频率。
在一个中心实施DBS的前8年中，收集了72例连续接受DBS治疗的患者（52例PD、11例肌张力障碍、9例ET）的141个电极的计划和最终放置数据。探讨了电极重新定位率与患者年龄、疾病持续时间以及实施时间/年份之间的关联。
对所有靶点的分析显示，最终电极放置有变化的占39.7%（56/141）；PD中为39.8%（41/103），肌张力障碍中为40.9%（9/22），ET中为37.5%（6/16）。年度分析显示，在该中心实施的第一年和第八年之间，重新定位率有所下降（p = 0.013）。在PD中，未发现电极重新定位率与患者年龄（p = 0.42）和疾病持续时间（p = 0.09）之间存在相关性。
这项回顾性分析证实了在DBS手术中，MER和术中测试刺激在确定手术早期/初期最终电极位置方面的益处。我们的研究结果显示，通过经验，我们中心在成功的术前规划方面存在学习曲线。
