Intraoperative electrocorticography for physiological research in movement disorders: principles and experience in 200 cases.
Intraoperative electrocorticography for physiological research in movement disorders: principles and experience in 200 cases.
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DOI：
10.3171/2015.11.jns151341
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发表时间：
2017-01
影响因子：
4.1
通讯作者：
Starr PA
中科院分区：
文献类型：
--
作者：
Panov F;Levin E;de Hemptinne C;Swann NC;Qasim S;Miocinovic S;Ostrem JL;Starr PA
运动障碍的病理生理学的当代理论强调基底神经节-丘脑皮质回路的异常振荡活动，但这些在人类中主要使用深度记录进行研究。使用皮层电图（ECoG）从皮层表面记录提供比深度记录高得多的振幅信号，不易受深部脑刺激（DBS）伪影的影响，并通过“宽带伽马”（50-200 Hz）活动产生群体尖峰的替代测量。因此，开发了一种采用术中ECoG作为研究工具的运动障碍手术技术方法。根据机构审查委员会批准的方案，对188例接受DBS治疗运动障碍的患者进行了研究。通过临床上适用于DBS电极导线插入的标准钻孔暴露，插入条形电极（6或28个触点）以覆盖主要运动或前额叶皮质区域。通过体感诱发电位反转和术中CT或2D透视确认定位。在休息和各种任务期间记录ECoG电位，并在频域中离线分析，重点关注3至200 Hz之间的活动。在闭合前取出条带。检查术后MRI是否存在可能与ECoG条带放置相关的水肿、信号变化或血肿。成功放置了198个（99%）条带。两次ECoG放置由于在尝试通过电极期间遇到阻力而中止。8例患者发生围手术期手术并发症，包括5例硬件感染、1例需要清除的迟发性慢性硬膜下血肿、1例脑实质内血肿和1例远离记录部位的静脉梗死。这些似乎都与ECoG的使用没有直接关系。术中ECoG长期以来一直用于神经外科的功能标测和癫痫灶的定位。在DBS手术中应用时，它已成为了解运动障碍和治疗刺激机制的大脑网络的重要研究工具。在经验丰富的手中，这项技术似乎给手术增加了最小的风险。
Contemporary theories of the pathophysiology of movement disorders emphasize abnormal oscillatory activity in basal ganglia-thalamocortical loops, but these have been studied in humans mainly using depth recordings. Recording from the surface of the cortex using electrocorticography (ECoG) provides a much higher amplitude signal than depth recordings, is less susceptible to deep brain stimulation (DBS) artifacts, and yields a surrogate measure of population spiking via “broadband gamma” (50–200 Hz) activity. Therefore, a technical approach to movement disorders surgery was developed that employs intraoperative ECoG as a research tool. One hundred eighty-eight patients undergoing DBS for the treatment of movement disorders were studied under an institutional review board–approved protocol. Through the standard bur hole exposure that is clinically indicated for DBS lead insertion, a strip electrode (6 or 28 contacts) was inserted to cover the primary motor or prefrontal cortical areas. Localization was confirmed by the reversal of the somatosensory evoked potential and intraoperative CT or 2D fluoroscopy. The ECoG potentials were recorded at rest and during a variety of tasks and analyzed offline in the frequency domain, focusing on activity between 3 and 200 Hz. Strips were removed prior to closure. Postoperative MRI was inspected for edema, signal change, or hematoma that could be related to the placement of the ECoG strip. One hundred ninety-eight (99%) strips were successfully placed. Two ECoG placements were aborted due to resistance during the attempted passage of the electrode. Perioperative surgical complications occurred in 8 patients, including 5 hardware infections, 1 delayed chronic subdural hematoma requiring evacuation, 1 intraparenchymal hematoma, and 1 venous infarction distant from the site of the recording. None of these appeared to be directly related to the use of ECoG. Intraoperative ECoG has long been used in neurosurgery for functional mapping and localization of seizure foci. As applied during DBS surgery, it has become an important research tool for understanding the brain networks in movement disorders and the mechanisms of therapeutic stimulation. In experienced hands, the technique appears to add minimal risk to surgery.