Deep brain stimulation for Parkinson's disease: Surgical technique and perioperative management
Deep brain stimulation for Parkinson's disease: Surgical technique and perioperative management
复制标题
DOI：
10.1002/mds.20959
复制
发表时间：
2006-01-01
影响因子：
8.6
通讯作者：
Benabid, Alim-Louis
中科院分区：
文献类型：
--
作者：
Machado, Andre;Rezai, Ali R.;Benabid, Alim-Louis
脑深部电刺激（DBS）是一种被广泛接受的治疗难治性帕金森病（PD）的方法。内苍白球（GPi）和丘脑底核（STN）刺激在改善PD症状和减轻运动障碍方面都是安全有效的。与GPi DBS相比，STN DBS是PD最常用的手术。腹侧中间核（Vim） DBS很少用于震颤为主的PD患者。患者选择是取得良好结果的关键。鉴别诊断应强调以及神经和非神经合并症。对左旋多巴刺激的良好反应是良好长期预后的重要预测指标。DBS手术通常在清醒状态下进行，包括立体定向框架应用、CT/MRI成像、解剖定位、生理确认以及DBS导联和脉冲发生器的植入。解剖定位包括目标在MR图像中的直接可视化，基于前后相交的公式导出坐标，以及重新格式化的解剖立体定向地图集。生理验证最常用的方法是通过微电极记录，然后植入DBS导联和术中测试刺激来评估益处和副作用。我们将介绍DBS手术的各个方面。(C) 2006运动障碍学会。
Deep brain stimulation (DBS) is a widely accepted therapy for medically refractory Parkinson's disease (PD). Both globus pallidus internus (GPi) and subthalamic nucleus (STN) stimulation are safe and effective in improving the symptoms of PD and reducing dyskinesias. STN DBS is the most commonly performed surgery for PD as compared to GPi DBS. Ventral intermediate nucleus (Vim) DBS is infrequently used as an alternative for tremor predominant PD patients. Patient selection is critical in achieving good outcomes. Differential diagnosis should be emphasized as well as neurological and nonneurological comorbidities. Good response to a levodopa challenge is an important predictor of favorable long-term outcomes. The DBS surgery is typically performed in an awake patient and involves stereotactic frame application, CT/MRI imaging, anatomical targeting, physiological confirmation, and implantation of the DBS lead and pulse generator. Anatomical targeting consists of direct visualization of the target in MR images, formula-derived coordinates based on the anterior and posterior commissures, and reformatted anatomical stereotactic atlases. Physiological verification is achieved most commonly via microelectrode recording followed by implantation of the DBS lead and intraoperative test stimulation to assess benefits and side effects. The various aspects of DBS surgery will be presented. (C) 2006 Movement Disorder Society.