改良硬脑膜破孔及密封法对帕金森病脑深部电刺激术中颅内积气改善作用的初步探讨

A preliminary study on the effect of modified dural perforation and sealing method on the improvement of pneumocephalus during deep brain stimulation in Parkinson′s disease

目的初步分析改良硬脑膜破孔及密封法对帕金森病(PD)脑深部电刺激(DBS)术中应用的安全性、有效性及其对颅内积气(ICA)的改善作用,探讨与可能影响双侧总ICA(TICA)因素的相关性。方法回顾性分析2020年1月至2021年12月郑州大学第一附属医院神经外科接受DBS手术治疗的46例PD患者的临床资料,患者均采用改良的硬脑膜破孔及密封方法植入双侧颅内电极,其中6例患者行局部麻醉,40例行全身麻醉,电极植入完成行头颅CT检查并应用3D Slicer软件后处理图像计算ICA体积,分析不同侧别ICA体积的差异;采用Pearson或Spearson相关系数法分析与可能影响TICA因素的相关关系。结果46例患者的DBS手术均顺利完成,共植入92根电极,术后无颅内出血等并发症发生。局部麻醉与全身麻醉患者手术时长分别为(153.33±42.74)min、(89.75±28.15)min,差异有统计学意义(t=4.82,P<0.001)。46例患者中,26例(56.5%)未发生ICA;20例(43.5%)发生ICA,TICA体积[M(Q_(1),Q_(3))]为0.38(0.13,2.10)cm^(3),其中TICA体积<1 cm^(3)的患者12例、1~5 cm^(3)5例、>5~10 cm^(3)1例、>10 cm^(3)2例。发生ICA患者的颅内左、右侧ICA体积[M(Q_(1),Q_(3))]分别为0.15(0.01,1.29)cm^(3)、0.05(0,1.67)cm^(3);首选手术侧、后选手术侧ICA体积[M(Q_(1),Q_(3))]分别为0.05(0,0.36)cm^(3)、0.11(0,1.86)cm^(3),差异均无统计学意义(均P>0.05)。术中是否微电极记录,ICA的发生率分别为52.2%(12/23)、34.8%(8/23),差异无统计学意义(P=0.373)。发生ICA患者的相关分析显示,患者的年龄、性别、麻醉方式、手术时长与TICA体积均无相关性(均P>0.05);病程与TICA体积呈负相关关系(P=0.027)。结论PD患者DBS术中应用改良硬脑膜破孔及密封法可改善术中ICA及减少术后并发症的发生,是一种安全、有效的方法,且发生ICA患者的TICA体积可能与其病程有关。

Objective To preliminarily analyze the safety and efficacy of the modified dural perforation and sealing method in deep brain stimulation(DBS)for Parkinson′s disease(PD)and its effect on the improvement of intracranial air(ICA)and the correlation with the factors that may affect.bilateral total intracranial air(TICA).Methods A retrospective analysis was performed on the clinical data of 46 patients with PD who underwent DBS surgery in the Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2021.All patients were implanted with bilateral intracranial electrodes using modified dural perforation and sealing methods,of which 6 patients underwent local anesthesia and 40 patients underwent general anesthesia.After the electrode implantation,head CT examination was performed and 3D slicer software was used for post-processing of images to calculate the volume of ICA.The difference in ICA volume on two sides and the factors affecting were analyzed.The correlation with possible TICA factors was analyzed by Pearson or Spearson correlation coefficient method.Results All DBS surgeries were successfully completed.A total of 92 electrodes in 46 cases were implanted successfully.There were no postoperative complications such as intracranial hemorrhage.Operation time related to bilateral electrode implantation for patients under local anesthesia and general anesthesia was 153.33±42.74 minutes and 89.75±28.15 minutes,respectively,with statistically significant differences(t=4.82,P<0.001).Of the 46 patients,26(56.5%)had no ICA and 20(43.5%)had a TICA volume[M(Q_(1),Q_(3))]of 0.38(0.13,2.10)cm^(3).Among them,TICA volume of<1 cm^(3) was observed in 12 cases,1-5 cm^(3) in 5 cases,>5-10 cm^(3) in 1 case,and>10 cm^(3) in 2 cases.The volume[M(Q_(1),Q_(3))]of left and right intracranial ICA in patients with ICA was 0.15(0.01,1.29)cm^(3) and 0.05(0,1.67)cm^(3),respectively.ICA volume[M(Q_(1),Q_(3))]of the first and second choice side was 0.05(0,0.36)cm^(3) and 0.11(0,1.86)cm^(3),respectively,with no statistical significance(both P>0.05).The incidence of ICA was 52.2%(12/23)and 34.8%(8/23),respectively,with or without microelectrode recording,and the difference was not statistically significant(P=0.373).The correlation analysis of ICA patients showed that age,sex,anesthesia method and operation time were not correlated with TICA volume(all P>0.05).The medical history was negatively correlated with TICA volume(P=0.027).Conclusion The modified dural perforation and sealing method in patients with PD can decrease the occurrence of intraoperative pneumocephalus and postoperative complications in DBS,which is a safe and effective method,and the volume of TICA in patients with ICA may be related to their disease course.