Clinical Motor Outcome of Bilateral Subthalamic Nucleus Deep-Brain Stimulation for Parkinson's Disease Using Image-Guided Frameless Stereotaxy
Clinical Motor Outcome of Bilateral Subthalamic Nucleus Deep-Brain Stimulation for Parkinson's Disease Using Image-Guided Frameless Stereotaxy
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DOI：
10.1227/neu.0b013e3181ecc887
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发表时间：
2010-10-01
期刊：
影响因子：
4.8
通讯作者：
Henderson, Jaimie M.
中科院分区：
文献类型：
--
作者：
Bronte-Stewart, Helen;Louie, Stephanie;Henderson, Jaimie M.
背景技术背景：在神经外科手术过程中，当需要精确、实时的解剖定位时，图像引导神经导航在很大程度上取代了立体定向框架。然而，一些程序，包括用于治疗运动障碍的脑深部电刺激（DBS）电极导线的放置，仍然使用基于框架的立体定向术进行。尽管基于框架和“无框架”图像引导方法之间的准确性相当，但无框架DBS放置的临床疗效从未报道过。目的：分析使用无框架技术治疗帕金森病（PD）的丘脑底核（DBS）DBS的结果。方法：在31例PD持续10 +/- 4年的受试者（20例男性）中，28例接受了双侧DBS，3例接受了单侧DBS。统一帕金森病评定量表（UMRS）运动量表（III）和总药物剂量在手术前进行了评估，并在6至12个月的UDBS治疗后进行了评估。结果：术后9.6 +/- 1.9个月，双侧SIN DBS在WARNRS III中改善了58%（术前40 +/- 16关闭，17 +/- 11关闭/打开）（P < .001）。这与使用基于帧的技术的已发表结果相比是有利的。所有运动分项评分均显著改善（P <0.01）。药物治疗的平均减少率为50%。未发生术中并发症，但1例高血压受试者死于术后迟发性出血。两名受试者术后感染，需要拆除铅和antibiotics.CONCLUSIONS：双边DBS的PD由一个经验丰富的团队使用无框架的方法进行的结果与报告的使用框架为基础的技术。
BACKGROUND: Image-guided neuronavigation has largely replaced stereotactic frames when precise, real-time anatomic localization is required during neurosurgical procedures. However, some procedures, including placement of deep-brain stimulation (DBS) leads for the treatment of movement disorders, are still performed using frame-based stereotaxy. Despite the demonstration of comparable accuracy between frame-based and "frameless" image-guided approaches, the clinical efficacy of frameless DBS placement has never been reported.OBJECTIVE: To analyze the outcomes of subthalamic nucleus (STN) DBS using the frameless technique for the treatment of Parkinson's disease (PD).METHODS: Of 31 subjects (20 men) with PD for 10 +/- 4 years, 28 had bilateral STN DBS and 3 had unilateral STN DBS. The Unified Parkinson's Disease Rating Scale (UPDRS) motor scale (III) and total medication doses were assessed before surgery on and off medication and off medication/ON DBS (off/ON) after 6 to 12 months of STN DBS.RESULTS: There was a 58% improvement from bilateral SIN DBS in the UPDRS III (40 +/- 16 preoperatively off, 17 +/- 11 off/ON) 9.6 +/- 1.9 months after surgery (P < .001). This compared favorably with the published outcomes using the frame-based technique. All motor subscores improved significantly (P < .01). The mean reduction in medication was 50%. No intraoperative complications occurred, but one subject with hypertension died of a delayed hemorrhage postoperatively. Two subjects developed postoperative infections that required lead removal and antibiotics.CONCLUSIONS: Bilateral STN DBS for PD performed by an experienced team using a frameless approach results in outcomes comparable to those reported with the use of the frame-based technique.