立体定向框架下帕金森病脑深部电刺激手术标准化流程的思考与改进

Analysis and optimization of standardized procedure for deep brain stimulation in Parkinson’s disease using stereotactic framework

目的探讨立体定向框架下帕金森病脑深部电刺激(DBS)手术标准化流程的细节及其改进措施。方法回顾分析2016年1月—2018年12月南京医科大学附属脑科医院神经内、外科联合评估后,行DBS治疗的236例中晚期帕金森病患者的临床资料。其中2例为单侧DBS,其余均为双侧,共470侧;术中采用改进后的手术流程,并关注手术细节;术后影像复查与手术计划对比,分析实际电极位置与计划的误差。结果本组患者最佳电极触点位置与计划位置相差(0.74±0.19)mm。术后发生皮层少量无症状出血者1例,≥30mL的颅内积气者3例。结论帕金森病DBS手术需要高度精细化,在每一个环节与细节应给予足够的注意与精细化的操作,才能提高电极植入的精确度。

Objective To explore the details of the process of deep brain stimulation(DBS)and its improvement measures using the stereotactic framework.Methods The clinical data of 236 patients with advanced Parkinson's disease(PD)admitted in the Brain Hospital Affiliated to Nanjing Medical University from January 2016 to December 2018,were analyzed retrospectively.Two of them were unilateral DBS,the others were bilateral,totaling 470 sides.The improved procedure was adopted during the operation,and the details of the operation were paid attention to.After the operation,the image review was compared with the operation plan,and the error between the actual electrode position and the plan was analyzed.Results The optimum electric shock position differed from the planned position by an average of(0.74±0.19)mm.There was 1 case of intracranial hemorrhage after operation.Severe intracranial gas accumulation in 3 cases(30 mL).Conclusion DBS surgery requires a high degree of refinement,with sufficient attention and meticulous manipulation in every step and detail to maximize electrode placement accuracy.