帕金森病脑深部电刺激术后电极错位修正2例报道及文献回顾

Deep brain stimulation lead revision surgery for Parkinson's Disease:2 case reports and literature review

目的探讨帕金森病(PD)脑深部电刺激(DBS)术后疗效不佳与电极错位的关系,以及靶点调整时机和方法、术后疗效改善分析。方法回顾性分析深圳大学第二附属医院2020年9月—2021年4月收治的2例因植入电极错位导致疗效不佳的DBS术后患者,分别行更换靶点和原靶点重新植入的修正手术,观察结果,结合文献加以总结。结果患者1的刺激靶点由双侧丘脑底核(STN)更换为双侧内侧苍白球(GPi),术前、术后药物关期刺激下UPDRS运动评分改善率32.1%,药物开期可改善46.4%;患者2行原左侧STN靶点电极取出并重新植入,术前、术后药物关期刺激下UPDRS运动评分改善率21.4%,药物开期可改善35.7%。结论脑深部电刺激术后,在明确诊断为与电极位置错位相关的疗效不佳时,有必要进行个体化的修正手术。

Objective To study the influencing factors,precautions and curative effect of the revision surgeries correcting electrode malposition in deep brain stimulation(DBS)in Parkinson's disease(PD)patients of low improvements after initial DBS therapy.Methods The clinical and imaging date at the same time the process and results of the retarget and reimplant surgeries of 2 patients who were admitted in Second Affiliated Hospital of Shenzhen University from September 2020 to April 2021 after initial DBS therapy were analyzed retrospectively,and the related literature were reviewed.Results In NO.1 patient,the stimulation target were changed from bilateral subthalamic nucleus(STN)to bilateral GPi,the UPDRS score improvement rate increased 32.1%in off medication period and 46.4%in the on phase.NO.2 patient was reimplanted with left STN,the UPDRS score improvement rate increased 21.4%in off medication period and 35.7%in the on phase.Conclusion Lead revision surgery could be a safe and effective remedy for the patients with suboptimal outcomes due to electrode malposition after initial DBS therapy.