基于电极偏差的靶点矫正法在脑深部电刺激术中的初步临床应用

Target correction based on electrode deviation in deep brain stimulation:a preliminary study

目的探讨基于电极偏差的靶点矫正法在脑深部电刺激术(DBS)中对提高电极植入精确性的临床应用价值。方法回顾性分析2014年3月至2018年4月浙江大学医学院附属第二医院神经外科行丘脑底核DBS治疗的61例帕金森病患者的临床资料。其中,2014年3月至2017年3月应用DBS治疗患者42例(84侧电极),为未矫正组,术后进行头颅MRI与CT融合并应用公式分别计算电极在X、Y、Z轴的偏差距离以及电极偏差值ΔP,并制定相应的靶点矫正规则;2017年4月至2018年4月纳入的19例患者(36侧电极)均参照此矫正规则进行靶点矫正,再行DBS治疗,为矫正组,术后复查头颅CT,并进行头颅MRI与CT融合后计算ΔP。将电极偏差程度按照ΔP≤1 mm、>1~2 mm、>2~3 mm和>3 mm进行划分。将电极植入靶点后无需术中调整定义为第1次穿刺成功。比较两组患者电极第1次穿刺成功率、ΔP以及电极偏差程度。结果两组患者手术均顺利完成,术后无致残、死亡等严重并发症,术后复查头颅CT结果均未见脑梗死或脑出血。未矫正组左侧ΔP为(1.6±0.9)mm,其中X轴向内移(0.1±0.9)mm,Y轴向后移(1.0±0.9)mm,Z轴向上移(0.5±0.5)mm;右侧ΔP中位数(上、下四分位数)为1.4(1.2,2.2)mm,其中X轴向内移(0.2±0.9)mm,Y轴向后移1.0(0.3,1.5)mm,Z轴向上移(0.4±0.5)mm,计算所得的靶点矫正规则为双侧Y轴向均向前增加1.0 mm,双侧Z轴向均向下增加0.5 mm。矫正组术中电极第1次穿刺成功率为94.4%(34/36),与未矫正组的77.4%(65/84)比较,差异有统计学意义(χ^(2)=5.082,P=0.024)。矫正组的左侧ΔP较未矫正组减小(t=-3.507,P=0.001);但矫正组的右侧ΔP与未矫正组比较,差异无统计学意义(Z=-1.646,P=0.100)。矫正组与未矫正组比较,双侧电极偏差程度的差异均具有统计学意义(均P<0.05)。结论基于电极偏差的靶点矫正法可提高术中电极第1次穿刺成功率,减小电极位置的偏差,对提高DBS电极植入精确性有一定的临床应用价值。

Objective To investigate the application of target correction method based on electrode deviation in deep brain stimulation(DBS),so as to determine whether target correction could improve the accuracy of electrode implantation.Methods Sixty-one Parkinson′s disease patients treated with subthalamic DBS from March 2014 to April 2018 at Neurosurgery Department,the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively included.Among those patients,42 patients(84 electrodes)who underwent DBS from March 2014 to March 2017 were categorized into the uncorrected group.After operation,MRI/CT fusion was performed.Formulas were used to calculate the overall deviation of the electrodes(ΔP)and directional deviation on the X,Y and Z axes.Target correction rules were made based on the deviation of electrodes.Nineteen patients(36 electrodes)who underwent DBS with target correction from April 2017 to April 2018 were categorized into the corrected group.After operation,MRI/CT fusion was performed andΔP was calculated.The electrode deviation degree was divided into 4 groups:ΔP≤1 mm,>1-2 mm、>2-3 mm and>3 mm.The first successful puncture was defined as follows:the electrode was implanted according to the target without adjustment.The success rate of the first puncture and the electrode deviation were compared between two groups.Results The operations in two groups were successfully performed without serious complications such as disability or death.No brain infarction or hemorrhage was observed on postoperative CT.In the uncorrected group,the meanΔP value of the left electrode was 1.6±0.9 mm,with X shifting medially by 0.1±0.9 mm,Y shifting posteriorly by 1.0±0.9 mm,and Z shifting upwards by 0.5±0.5 mm.The medianΔP value of the right electrode(upper and lower quartile)was 1.4(1.2,2.2)mm,with X shifting medially by 0.2±0.9 mm,Y shifting posteriorly by 1.0(0.3,1.5)mm,and Z shifting upwards by 0.4±0.5 mm.Target correction was conducted based on the deviation data as above:Y was adjusted by 1.0 mm anteriorly on both sides,and Z was adjusted by 0.5 mm downwards on both sides.The success rate of the first puncture in the corrected group was 94.4%(34/36),which was higher than that in uncorrected group(77.4%,65/84).The difference was statistically significant(χ^(2)=5.082,P=0.024).In the corrected group,theΔP value of the left electrode was smaller(t=-3.507,P=0.001)than that in uncorrected group,while theΔP value of the right electrode showed no statistical difference(Z=-1.646,P=0.100).The deviation degree of bilateral electrodes in the corrected group were statistically different(P<0.05)when compared with uncorrected group.Conclusion The target correction method based on electrode deviation can improve the success rate of the first electrode puncture,reduce the deviation,and has clinical application value in accuracy improvement of DBS electrode implantation.