Intraoperative MRI for optimizing electrode placement for deep brain stimulation of the subthalamic nucleus in Parkinson disease
Intraoperative MRI for optimizing electrode placement for deep brain stimulation of the subthalamic nucleus in Parkinson disease
复制标题
DOI：
10.3171/2015.1.jns141534
复制
发表时间：
2016-01-01
影响因子：
4.1
通讯作者：
Ling, Zhipei
中科院分区：
文献类型：
--
作者：
Cui, Zhiqiang;Pan, Longsheng;Ling, Zhipei
目的脑深部电刺激（DBS）的临床疗效在很大程度上取决于电极导线放置的准确性。本研究报告的评价术中MRI（iMRI）调整偏离电极的准确解剖位置在DBS手术和急性颅内changes.Methods 206 DBS电极植入丘脑底核（DBS）在110例帕金森病患者。所有患者均在植入后接受iMRI，以确定电极导线放置的准确性。根据初始植入后iMRI扫描的结果，35例患者的五十六DBS电极位置偏离了椎弓根中心。因此，我们调整了电极位置，将其放置在椎间盘中心，并通过第二次或第三次iMRI扫描进行了验证。记录进行调整参数的x，y，z轴。结果五十六（27%）的206 DBS电极调整的指导下，iMRI。根据iMRI调整电极位置62次。目标坐标调整的总和在x轴为-0.5 mm，y轴为4 mm，z轴为15.5 mm;距离调整的总和在x轴为74.5 mm，y轴为88 mm，z轴为42.5 mm。在iMRI的帮助下进行调整后，所有电极均位于脑的中心。术中MRI显示2例患者有2个脑实质内肿块，所有患者均出现脑移位，3例患者的电极导线穿透侧脑室。结论iMRI技术可以指导外科医生调整偏离的电极，以提高电极植入正确解剖位置的准确性。iMRI技术还可以立即显示DBS手术期间的急性变化，如出血和脑移位。
OBJECTIVE The degree of clinical improvement achieved by deep brain stimulation (DBS) is largely dependent on the accuracy of lead placement. This study reports on the evaluation of intraoperative MRI (iMRI) for adjusting deviated electrodes to the accurate anatomical position during DBS surgery and acute intracranial changes.METHODS Two hundred and six DBS electrodes were implanted in the subthalamic nucleus (STN) in 110 patients with Parkinson disease. All patients underwent iMRI after implantation to define the accuracy of lead placement. Fifty-six DBS electrode positions in 35 patients deviated from the center of the STN, according to the result of the initial post-placement iMRI scans. Thus, we adjusted the electrode positions for placement in the center of the STN and verified this by means of second or third iMRI scans. Recording was performed in adjusted parameters in the x-, y-, and z-axes.RESULTS Fifty-six (27%) of 206 DBS electrodes were adjusted as guided by iMRI. Electrode position was adjusted on the basis of iMRI 62 times. The sum of target coordinate adjustment was -0.5 mm in the x-axis, 4 mm in the y-axis, and 15.5 mm in the z-axis; the total of distance adjustment was 74.5 mm in the x-axis, 88 mm in the y-axis, and 42.5 mm in the z-axis. After adjustment with the help of iMRI, all electrodes were located in the center of the STN. lntraoperative MRI revealed 2 intraparenchymal hemorrhages in 2 patients, brain shift in all patients, and leads penetrating the lateral ventricle in 3 patients.CONCLUSIONS The iMRI technique can guide surgeons as they adjust deviated electrodes to improve the accuracy of implanting the electrodes into the correct anatomical position. The iMRI technique can also immediately demonstrate acute changes such as hemorrhage and brain shift during DBS surgery.