脑结构位移对脑深部电刺激电极移位的影响

Influence of brain shift on lead displacement during deep brain stimulation

目的探讨脑结构位移对脑深部电刺激(DBS)电极移位的影响及其相关因素。方法回顾性分析2018年10月—2021年6月北京天坛医院收治的268例接受双侧丘脑底核(STN)DBS和31例接受双侧苍白球内侧部(GPi)DBS的患者。电极定位基于术前磁共振成像(MRI)、术后即刻和长期随访的计算机断层扫描(CT)。进一步,研究者还测量了单侧气颅体积百分比(uPVP)和脑体积百分比,探究其是否会影响电极移位。结果采用医学图像配准软件(ANTs)和脑结构位移校正可以精确配准。在STN-DBS中,使脑结构位移影响最小化后,电极术后即刻的位置向内(0.29±0.47)mm,向后(0.63±0.55)mm。在GPi-DBS中,得到了不同的结果,向内(0.21±0.66)mm,向后(0.96±0.53)mm,向腹(0.17±0.67)mm。并且uPVP与电极移位显著相关。结论术后即刻电极位置向内,向后,向腹侧移位,并且与uPVP有关。

Objective To explore the effect of brain shift on electrode displacement during deep brain stimulation(DBS)and its related factors.Methods A total of 268 patients who underwent bilateral subthalamic nucleus(STN)DBS and 31 patients who underwent bilateral internal globus pallidus(GPi)DBS,admitted to Beijing Tiantan Hospital from October 2018 to June 2021,were involved in this study.The lead localization was based on preoperative magnetic resonance imaging(MRI),immediate postoperative and longer follow-up computed tomography(CT).Unilateral pneumocephalus volume percent(uPVP)and brain volume percent were also evaluated.Results Advanced normalization tools(ANTs)followed by brain shift correction performed efficiently.After minimizing brain shift during STN-DBS,lead position immediately postoperation was(0.29±0.47)mm medial and(0.63±0.55)mm posterior.Slightly different results were obtained in GPi-DBS(0.21±0.66)mm medial,(0.96±0.53)mm posterior,and(0.17±0.67)mm ventral.The uPVP was significantly related to lead displacement.Conclusion The lead position immediately post-operation is medially,posteriorly and ventrally displaced,and is related to uPVP.