帕金森病丘脑底核脑深部电刺激术术中及术后CT影像电极位置偏移特点分析

Displacement characteristics of intraoperative and postoperative positions of electrodes on CT imaging for subthalamic nucleus-deep brain stimulation in Parkinson＇s disease

目的探讨帕金森病（PD）丘脑底核脑深部电刺激术（STY—DBS）术中及术后CT影像上电极位置偏移特点。方法回顾性分析南方医科大学珠江医院神经外科自2014年1月至2018年6月收治的35例接受STN-DBS治疗的PD患者的术前MRj影像、术中及术后CT影像资料。以术前MRI为蓝本建立三维直角坐标系，运用MRI／CT融合技术将术中及术后CT影像与术前MRI融合，定位术中及术后电极位置，分析术中电极与术后电极位置坐标偏差，总结位置偏移特点。利用线性回归分析双侧的坐标偏差特点与对应变量间的相关性。结果双侧电极术后位置与术中位置的空间距离在1mm左右，深度（z轴）偏移极小。侧旁轴（x轴）上第1侧电极术后位置较术中位置向外偏移明显；第2侧电极向内偏移，偏移程度小。前后轴（y轴）上第1侧电极向后偏移明显；第2侧电极向后偏移较小。双侧电极中，术中电极-术前靶点、术后电极-术前靶点对应的三轴坐标偏差间均呈显著的线性正相关关系。结论STN．DBS术后电极位置与术中电极位置的偏移存在较为明显的规律，可指导术中电极的调整及推测术后电极位置。

Objective To investigate the displacement characteristics of intraoperative and postoperative positions of electrodes on CT imaging for bilateral subthalamic nucleus-deep brain stimulation （STN-DBS） in Parkinson＇s disease （PD）. Methods A retrospective analysis on preoperative MR imaging, intraoperative and postoperative CT images of 35 patients with PD treated with STN-DBS in our hospital from January 2014 to June 2018 was performed. A three-dimensional coordinate system was established based on preoperative MR imaging. MR imaging/CT fusion technique was used to fuse intraoperative and postoperative CT images with preoperative MR imaging to locate intraoperative and postoperative electrode positions. The displacement characteristics of intraoperative and postoperative electrodes were analyzed. Results The spatial distance between intraoperative and postoperative positions of bilateral electrodes was about 1 mm, and the depth displacement was minimal. The postoperative position of the first side electrode on lateral axis was shifted outwardly from intraoperative position, and the second side electrode was shifted internally with a small degree; on anterior-posterior axis, the first side electrode obviously shifted backward, and the second side electrode slightly shifted backward. For bilateral electrodes, corresponding coordinate deviation of three axis between intraoperative electrode-preoperative target and postoperative electrode-preoperative target, showed a significant positive linear correlation, therefore, leading out the coordinate deviation regression function model. Conclusions The displacement of electrodes between intraoperative and postoperative positions has obvious rules after STN-DBS in PD, which can guide the adjustment of intraoperative electrode position and predict the postoperative position of electrode.