Subthalamic nucleus stimulation in Parkinson's disease:: Postoperative CT-MRI fusion images confirm accuracy of electrode placement using intraoperative multi-unit recording
Subthalamic nucleus stimulation in Parkinson's disease:: Postoperative CT-MRI fusion images confirm accuracy of electrode placement using intraoperative multi-unit recording
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DOI：
10.1016/j.neucli.2007.09.005
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发表时间：
2007-12-01
影响因子：
3
通讯作者：
Nguyen, J. -P.
中科院分区：
文献类型：
--
作者：
Shin, M.;Lefaucheur, J. -P.;Nguyen, J. -P.
颅底核深部脑刺激（DBS）越来越多地用于治疗晚期帕金森病（PD）。在植入最终DBS电极之前靶向STN的最佳方法仍然是一个争论的问题。除了基于立体定向磁共振成像（MRI）的细胞核直接可视化方法外，针对STN最常用的技术是沿着10-15毫米长的探索轨迹记录单细胞活动，以理论或MRI定义的目标坐标为中心。微电极单单元记录存在各种缺点。考虑到植入电极的大小，如果操作正确，它们是耗时的，而且单细胞精度可能是多余的。在这项研究中，我们提出了一种记录和量化术中用半微电极靶向STN记录的多单元信号的原始方法。在多单元电生理记录指导下，纳入12例晚期PD患者，在双侧STN-DBS电极植入前和植入后1年进行临床评估。经过一年的慢性刺激，所有患者的临床症状均有明显改善。与非刺激停药组相比，刺激停药组帕金森病统一评定量表运动评分下降57%以上，所需左旋多巴当量日剂量下降59.5%。STN-DBS导联放置的准确性在术后计算机断层扫描（CT）上得到证实，并与术前t2加权MRI融合。多单位信号幅度的增加可以很容易地确定海带的边界，从海带吻侧边界以下0.492 mm到尾侧边界以上0.325 mm，平均可见海带吻侧边界的增加。吻侧和尾侧STN边缘的信号幅值均显著升高（P < 0.05），神经元活动水平容易区分核内外。本研究表明，在半微电极术中多单元记录的基础上，可以充分确定STN边界。我们将DBS电极定位到STN的方法的准确性在CT-MRI融合图像和治疗效率上都得到了证实。(c) 2007年Elsevier Masson SAS。版权所有。
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is increasingly used to treat advanced Parkinson's disease (PD). The optimal method for targeting the STN before implanting the definitive DBS electrode is still a matter of debates. Beside methods of direct visualization of the nucleus based on stereotactic magnetic resonance imaging (MRI), the most often used technique for targeting STN consists in recording single-cell activity along exploratory tracks of 10-15 mm in length, centered on the theoretical or MRI-defined target coordinates. Single-unit recordings with a microelectrode present various drawbacks. They are time-consuming if correctly performed and a single-cell precision is probably superfluous, taking into account the size of the implanted electrode. In this study, we present an original method of recording and quantification of a multi-unit signal recorded intraoperatively with a semi-microelectrode for targeting the STN. Twelve patients with advanced PD have been included and assessed clinically before and one year after bilateral STN-DBS electrode implantation guided by multi-unit electrophysiological recordings. After one year of chronic stimulation, all patients showed a marked clinical improvement. The motor score of the unified Parkinson's disease rating scale decreased by more than 57% and the required levodopa-equivalent daily dose by 59.5% in on-stimulation off-medication condition compared to off-stimulation off-medication condition. The accuracy of STN-DBS lead placement was confirmed on postoperative computed tomography (CT) scans, which were fused to preoperative T2-weighted MRI. The boundaries of the STN were easily determined by an increase in multi-unit signal amplitude, which was observed on average from 0.492 mm below the rostral border of the STN down to 0.325 mm above its caudal border. Signal amplitude significantly increased at the both rostral and caudal STN margins (P < 0.05) and the level of neuronal activity easily distinguished inside from outside the nucleus. This study showed that STN boundaries could be adequately determined on the basis of intraoperative multi-unit recording with a semi-microelectrode. The accuracy of our method used for positioning DBS electrodes into the STN was confirmed both on CT-MRI fusion images and on the rate of therapeutic efficacy. (c) 2007 Elsevier Masson SAS. All rights reserved.