Surgical Repositioning of Misplaced Subthalamic Electrodes in Parkinson's Disease: Location of Effective and Ineffective Leads
Surgical Repositioning of Misplaced Subthalamic Electrodes in Parkinson's Disease: Location of Effective and Ineffective Leads
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DOI：
10.1159/000230692
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发表时间：
2009-01-01
影响因子：
1.7
通讯作者：
Starr, Philip A.
中科院分区：
文献类型：
--
作者：
Richardson, R. Mark;Ostrem, Jill L.;Starr, Philip A.
关于在帕金森病的丘脑下核（STN）靶区放置深部脑刺激（DBS）电极的最佳位置，目前还没有明确的共识。如果导联放置后症状控制不佳或出现不良反应，则推定导联放置不当，可通过手术矫正。我们回顾性分析了8例接受外科导联修复的患者，以研究有效导联放置的解剖边界。再次手术使针对STN背外侧的DBS导联位置改变2-5 mm，使这些患者的临床改善显著。改善是由于更好的症状控制，减少刺激引起的不良反应或两者兼而有之。在许多情况下，STN外围区的导线被重新定位到核感觉运动区域内更中心的位置。这些结果与其他研究的结果形成对比，这些研究表明，在STN边界区域或邻近的白质束中放置最佳的铅。版权所有(C) 2009 S. Karger AG，巴塞尔
There is no clear consensus regarding the optimal location for placing deep brain stimulation (DBS) electrodes within the subthalamic nucleus (STN) target region in Parkinson's disease. In cases of poor symptom control or adverse effects following lead placement, leads presumed to be inadequately positioned may be corrected by surgical revision. We retrospectively analyzed a series of 8 patients who underwent surgical lead revision, to study the anatomic boundaries of effective lead placement. Reoperation to achieve changes of 2-5 mm in DBS lead position targeting the dorsolateral part of the STN produced significant clinical improvement in these patients. Improvements were due to better symptom control, reduction of stimulation-induced adverse effects or both. In many cases, leads in a peripheral zone of the STN were repositioned to a more central location within the sensorimotor territory of the nucleus. These results are contrasted with findings in other studies demonstrating optimal lead placement in STN border zones or neighboring white-matter tracts. Copyright (C) 2009 S. Karger AG, Basel