帕金森病分期双侧脑深部电刺激手术期间的连续脑移位模式

Sequential Brain Shift Patterns During Staged Bilateral Deep Brain Stimulation Surgery for Parkinson's Disease.

作者信息

Kim Junhyung, Jo Sungyang, Chung Sun Ju, Hong Seok Ho, Jeon Sang Ryong

机构信息

Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

出版信息

Oper Neurosurg. 2025 Jun 24. doi: 10.1227/ons.0000000000001664.

DOI:10.1227/ons.0000000000001664

PMID:40552887

Abstract

BACKGROUND AND OBJECTIVES

Brain shift is a major contributor to targeting errors in stereotactic procedures. This study investigates sequential brain shift patterns during deep brain stimulation (DBS) surgery and discusses the clinical implications of using a staged bilateral targeting strategy in Parkinson's disease.

METHODS

Quantitative image analysis was conducted for 210 DBS procedures in 105 patients with Parkinson's disease undergoing staged bilateral operations. Brain shift was quantified by coordinate displacements of subcortical structures, including the globus pallidus internus (GPi) and subthalamic nucleus (STN), across 4 MRI sessions during the 2 staged DBS procedures. Brain shift was evaluated in 3 configurations: pre-first vs post-first DBS MRIs (ⅰ), pre-first vs post-second DBS MRIs (ⅱ), and pre-second vs post-second DBS MRIs (ⅲ).

RESULTS

Brain shift was predominant in posterior, inferior, and medial directions, with greater magnitude in the GPi than in the STN. After the first DBS procedure (ⅰ), clinically relevant brain shift (displacement >3 mm) was observed in 6.8% of the GPi, while none was noted in the STN. After the second DBS procedure (ⅱ), brain shift was observed in up to 20.3% of the GPi and 4.1% of the STN on the second targeted side. However, when evaluated relative to the rescanned MRI (ⅲ), brain shifts within the second DBS procedure were reduced to 4.1% for the GPi and none for the STN, supporting the importance of precise target adjustment via a staged bilateral strategy. The extent of pneumocephalus showed the strongest correlation with the posterior displacement of the GPi, and low intraoperative mean arterial pressure appeared to be significantly associated with an increased risk of brain shift in this cohort.

CONCLUSION

These findings suggest that brain shift should be an important consideration in bilateral DBS surgery, and staged operations may provide particular advantages when targeting the GPi.

摘要

背景与目的

脑移位是立体定向手术中导致靶点误差的主要因素。本研究调查了深部脑刺激（DBS）手术过程中的连续脑移位模式，并讨论了在帕金森病中采用分期双侧靶点策略的临床意义。

方法

对105例接受分期双侧手术的帕金森病患者的210次DBS手术进行了定量图像分析。通过在2期DBS手术的4次MRI检查中，包括内侧苍白球（GPi）和丘脑底核（STN）在内的皮质下结构的坐标位移来量化脑移位。在3种情况下评估脑移位：第一次DBS MRI检查前与第一次DBS MRI检查后（ⅰ）、第一次DBS MRI检查前与第二次DBS MRI检查后（ⅱ）以及第二次DBS MRI检查前与第二次DBS MRI检查后（ⅲ）。

结果

脑移位主要发生在后方、下方和内侧方向，GPi的移位幅度大于STN。在第一次DBS手术后（ⅰ），6.8%的GPi观察到具有临床意义的脑移位（位移>3 mm），而STN未观察到。在第二次DBS手术后（ⅱ），在第二次靶向侧，高达20.3%的GPi和4.1%的STN观察到脑移位。然而，当相对于重新扫描的MRI进行评估时（ⅲ），第二次DBS手术中的脑移位在GPi中降至4.1%，在STN中未观察到，这支持了通过分期双侧策略进行精确靶点调整的重要性。气颅程度与GPi的后向位移相关性最强，术中平均动脉压低似乎与该队列中脑移位风险增加显著相关。