Advances in Technical Aspects of Deep Brain Stimulation Surgery.
Advances in Technical Aspects of Deep Brain Stimulation Surgery.
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DOI：
10.1159/000529040
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发表时间：
2023
影响因子：
1.7
通讯作者：
Chang, Jin Woo
中科院分区：
文献类型：
--
作者：
Schulder, Michael;Mishra, Akash;Mammis, Antonios;Horn, Andres;Boutet, Alexandre;Blomstedt, Patric;Chabardes, Stephan;Flouty, Oliver;Lozano, Andres M.;Neimat, Joseph S.;Ponce, Francisco;Starr, Philip A. A.;Krauss, Joachim K. K.;Hariz, Marwan;Chang, Jin Woo
脑深部刺激已经成为一项成熟的技术，用于治疗各种情况的患者，包括运动障碍、精神障碍、癫痫和疼痛。植入DBS装置的手术增强了我们对人类生理学的了解，这反过来又导致了DBS技术的进步。我们的小组之前已经发表了这些进展，提出了未来的发展，并检查了星状细胞瘤的不断演变的适应症。描述了DBS前、中、后结构磁共振成像在靶点可视化和靶点确认中的关键作用，并讨论了新的MR序列和高场强MRI能够直接显示脑目标。本文综述了功能成像和连通性成像在手术过程中的应用及其对解剖模型的贡献。综述了靶向和植入电极的各种工具，包括基于框架的、无框架的和机器人辅助的，并描述了它们的优缺点。介绍了最新的脑地图集和用于规划目标坐标和轨迹的各种软件。我们讨论了睡眠手术和清醒手术的利弊。描述了微电极记录和局部场电位的作用和价值，以及术中刺激的作用。介绍和比较了新型电极设计和植入式脉冲发生器的技术方面。DBS作为一种治疗手段正在迅速发展，随着立体定向技术、手术技术和影像技术的发展，DBS系统的植入技术也有了很大的提高。DBS技术和手术的创新有望使DBS手术更准确和有效，有可能改善更广泛患者的结果，前提是技术进步不会变得如此复杂和繁琐，以至于它们的传播和广泛使用受到阻碍。还需要额外的多学科工作，旨在使这些技术进步更加方便用户，这应该会带来更多的患者利益。
Deep brain stimulation has become an established technology for the treatment of patients with a wide variety of conditions, including movement disorders, psychiatric disorders, epilepsy, and pain. Surgery for implantation of DBS devices has enhanced our understanding of human physiology, which in turn has led to advances in DBS technology. Our group has previously published on these advances, proposed future developments, and examined evolving indications for DBS. The crucial roles of structural MR imaging pre-, intra-, and post-DBS procedure in target visualization and confirmation of targeting are described, with discussion of new MR sequences and higher-field strength MRI enabling direct visualization of brain targets. The incorporation of functional and connectivity imaging in procedural workup and their contribution to anatomical modelling is reviewed. Various tools for targeting and implanting electrodes, including frame-based, frameless, and robot-assisted, are surveyed, and their pros and cons are described. Updates on brain atlases and various software used for planning target coordinates and trajectories are presented. The pros and cons of asleep versus awake surgery are discussed. The role and value of microelectrode recording and local field potentials are described, as well as the role of intraoperative stimulation. Technical aspects of novel electrode designs and implantable pulse generators are presented and compared. DBS as a therapeutic procedure is rapidly expanding, and the techniques of DBS system implantation have been greatly improved by developments in stereotactic technology, surgical techniques, and imaging. Innovations in DBS technology and surgery promise to make DBS surgery more accurate and effective, with potentially improved outcomes for a wider spectrum of patients, provided that technological advancements do not become so complicated and cumbersome that their dissemination and widespread use are hindered. Additional multidisciplinary work is needed, aiming at making these technological advances more user-friendly, which should result in further patient benefits.
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