帕金森病患者丘脑底核电极植入术中位置判断和调整

Intraoperative verification and adjustment of subthalamic nucleus electrode placement in deep brain stimulation for Parkinson's disease

目的探讨帕金森病患者脑深部刺激术(DBS)中丘脑底核(STN)电极植入位置准确性判断和调整。方法对137例帕金森病(PD)患者进行了丘脑底核DBS治疗,其中单侧68例,双侧69例。采用磁共振扫描,图像直接定位和坐标值定位相结合的方法计算靶点坐标,微电极记录细胞外放电。术中采用微毁损效应,观察刺激效果和副作用,X线透视和带立体定向头架MRI复查。结果绝大部分患者都能观察到电极植入的微毁损效应、电刺激效果和刺激副作用,术中X线透视和带立体定向头架MRI复查能观察到电极实际位置,并进行必要的调整。结论通过微毁损效应、电刺激效果和刺激副作用观察以及术中影像学检查能及时纠正电极位置偏差,减少二次手术,从而提高PD患者的DBS疗效。

Objective To analyse the methods of verifying subthalamic nucleus target localization accuracy in deep brain stimulation for Parkiuson＇ s disease （PD）. Method 137 patients with medically intractable PD underwent unilateral subthalamic （68 cases ） or bilateral subthalamic （69 cases ） stimulation. The anatomic target coordinates were calculated by a combination of direct and indirect MRI neuroimaging. Microelectrode recording was performed. Subthalamic nucleus target localization accuracy was checked. Results Accuracy of stereotatic electrode placement can be verified by our observation of micro-ablative effects, test stimulation- induced effects and side-effects, intraoperative X-ray or intraoperative MRI while the patient had the stereotactic frame on the head. Conclusions verification of Subthalamic nucleus target localization accuracy by these methods is helpful in getting favorable outcome.