脂质头皮标志物在脑深部电刺激术针道设计中的应用

目的探讨脂质胶丸作为头皮标志物在脑深部电刺激术(DBS)前MRI定位扫描时针道设计中的应用价值。方法回顾性分析2011年11月至2017年4月采用DBS治疗的104例运动异常的临床资料,其中帕金森病96例,特发性震颤3例,肌张力障碍5例;应用脂质胶丸作为头皮标志物辅助设计针道45例(84侧,观察组),未采用脂质胶丸59例(103侧,对照组)。测量电极入颅点调整距离,观察术后针道出血及穿过侧脑室情况,比较术后1个月开机时统一帕金森病评分运动功能量表(UPDRSⅢ)评分改善率。结果观察组共调整48侧(57.1%),调整距离在3~10 mm,皮层下无症状性出血1侧。对照组发现针道穿过侧脑室5侧、皮层下出血3侧。观察组并发症发生率(1.2%,1/84)明显低于对照组(7.8%,8/103;P0.05)。术后1个月开机,观察组UPDRSⅢ评分改善率[(64.1±13.5)%]与对照组[(63.4±12.0)%]无明显差异(P0.05)。结论应用脂质胶丸作为头皮标志物在DBS中辅助针道设计简便易行,对减少颅内出血及针道穿过侧脑室具有积极意义。

Application of lipid scalp markers to the design of electrode track for deep brain stimulation in patients with movement disorders

Objective To explore the value of lipid pellet serving as scalp marker to the design of electrode track for deep brain stimulation (DBS) during MRI locating scan in the patients with movement disorders. Methods Of 104 patients (187 sides) with movement disorders treated with DBS from November, 2011 to April, 2017, 45 (84 sides, observed group) received the lipid pellets (serving as markers)-assisted design of electrode tracks and 59 (103 sides, control group) not. Of 104 patients with movement disorders, 96 suffered from Parkinson's disease, 3 essential tremor and 5 dystonia. The adjusted distance of the electrode entry point was measured. The hemorrhage in the electrode tracks and the electrode track passed the lateral ventricle were observed and recorded. Unified Parkinson Disease Rating scale scores (UPDRS III) under the stimulation conditions were determined in all the patients before the surgery and after the surgery. Results In the observed group, the electrode entry points of 48 sides (57.1%) were adjusted under the guidance of lipid pellets and the adjusted distances ranged from 3 to 10 mm. The CT scan showed that the asymptomatic subcortical hemorrhage around the track in 1 side in the observed group. In the control group, MRI showed that the tracks passed the lateral ventricles in 5 sides and asymptomatic subcortical hemorrhage in 3 sides was found. The rate of postoperative complication was significantly lower in obseraved group (1.2%, 1/84) than taht (7.8%, 8/103) in control group (P<0.05). UPDRS scores 1 month after the surgery were (16.0±9.5) points and (14.7±7.5) points respectively in the observed and control groups. There was no significant difference in UPDRS scores 1 month after the surgery between both the groups (P>0.05). Conclusion The lipid pellet (severing as scalp marker)-assisted design of the electrode track for DBS is simple and feasible in the patients with PD and can reduce bleeding in the electrode track and avoid passing the lateral ventricle.