神经外科机器人辅助脑深部电刺激治疗高龄帕金森病的疗效分析

The efficacy analysis of neurosurgical robot-assisted DBS in the treatment of elderly Parkinson′s disease

目的探讨神经外科机器人脑深部电刺激(DBS)治疗高龄帕金森病(PD)的手术疗效。方法回顾性收集2016年9月至2022年9月在北部战区总医院神经外科行神经外科机器人辅助DBS手术的高龄(≥75岁)PD患者的临床资料,分析统计手术时间、电极植入时间、术后颅内积气,电极植入精度,陶氏DBS手术评分、围手术期并发症,药物关期时术前、术后6、12、24个月及末次随访时的统一帕金森病评定量表(UPDRS)、UPDRS-Ⅲ、震颤、强直、运动迟缓、轴性症状、日常生活活动指数(ADL-Barthel)、左旋多巴等效日剂量(LEDD)、蒙特利尔认知评估量表(MoCA)、汉密顿焦虑量表(HAMA)及汉密顿抑郁量表(HAMD)等评分及死亡情况。结果共入组25例高龄患者,男14例,女11例,年龄(78.3±3.2)岁,9例患者合并基础疾病。其中双侧苍白球内侧部脑深部电刺激术(GPi-DBS)9例(36%),双侧丘脑底核脑深部电刺激术(STN-DBS)16例(64%)。手术时间(1.56±0.19)h,电极植入时间(1.01±0.19)h,颅内积气体积9.8(4.7,23.3)cm^(3),电极植入精度为(0.84±0.24)mm,陶氏DBS手术评分(80.2±6.2)分。随访时间[M(Q_(1),Q_(3))]57.3(27.9,75.7)个月,围手术期没有发生颅内出血、感染、切口愈合不良等严重并发症。术后6个月UPDRS、UPDRS-Ⅲ、强直、运动迟缓、LEDD的改善率明显高于术后24个月及末次随访改善率(均P<0.05);术后6个月轴性症状、ADL-Barthel评分、MoCA评分改善率明显高于末次随访时改善率(P<0.05)。HAMD、HAMA评分在术后随访中均未见明显改善(均P>0.05)。至末次随访时有12例患者死亡,死亡时间为术后(35.1±20.2)个月,死亡年龄为[M(Q_(1),Q_(3))]80(79,83)岁。结论高龄PD患者接受机器人辅助DBS手术治疗精准安全,术后症状改善明显,并且可以通过程控持续获益,风险可控。

Objective To investigate the surgical efficacy of neurosurgery robot deep brain stimulation(DBS)in the treatment of elderly Parkinson′s disease(PD).Methods The clinical data of elderly patients(≥75 years)with PD who underwent neurosurgical robot-assisted DBS surgery in the Department of Neurosurgery of the General Hospital of Northern Theater Command from September 2016 to September 2022 were collected retrospectively.Operation time,electrode implantation duration,postoperative pneumocephalus volume,electrode implantation accuracy,the Tao′s DBS surgery scale,perioperative complications were analyzed.The unified Parkinson′s disease rating scales(UPDRS),UPDRS-Ⅲ,tremor,rigidity,bradykinesia,axial,Barthel Activities of Daily Living(ADL-Barthel),Levodopa Equivalent Daily Dose(LEDD),Montreal Cognitive Assessment(MoCA),Hamilton Anxiety Scale(HAMA)and Hamilton Depression Scale(HAMD)scores and mortality were assessed respectively before operation,6,12 and 24 months after operation and last follow-up.Results A total of 25 elderly patients were enrolled,including 14 males and 11 females,aged(78.3±3.2)years.Nine patients had underlying diseases.Nine patients(36%)underwent bilateral Globus Pallidus pars Interna deep brain stimulation(GPi-DBS)and 16 patients(64%)underwent bilateral subthalamic nucleus deep brain stimulation(STN-DBS).The operation time was(1.56±0.19)hours,the electrode implantation duration was(1.01±0.19)hours,the pneumocephalus volume was 9.8(4.7,23.3)cm^(3),and the electrode implantation accuracy was(0.84±0.24)mm,the Tao′s DBS surgery scale was(80.2±6.2).The follow-up time[M(Q_(1),Q_(3))]was 57.3(27.9,75.7)months.No serious complications such as intracranial hemorrhage,infection or poor wound healing occurred during the perioperative period.The improvement rate of UPDRS,UPDRS-Ⅲ,rigidity,bradykinesia,and LEDD at 6 months after surgery was significantly higher than that at 24 months after surgery and at the last follow-up(all P<0.05);the improvement rate of axial symptoms,ADL-Barthel score,and MoCA score at 6 months after surgery was significantly higher than that at the last follow-up(P<0.05).HAMD and HAMA scores showed no significant improvement during follow-up after surgery(both P>0.05).At the last follow-up,12 patients died,with death time of(35.1±20.2)months after operation,and the death age of[M(Q_(1),Q_(3))]80(79,83)years.Conclusions Robot-assisted DBS surgery for elderly patients with PD is accurate and safe,and the postoperative symptoms are significantly improved,and they can benefit from neuromodulation for long term,and the risks are controllable.