脑深部刺激手术技术要点探讨

目的为提高脑深部刺激(deep brain stimulation,DBS)手术疗效、降低并发症,总结其手术技术要点。方法 2000年3月～2011年10月年共有222例患者进行了DBS手术,其中帕金森病207例,特发性震颤5例,肌张力障碍10例。刺激靶点355个,其中丘脑底核325个,腹中间核14个,苍白球内侧部16个。穿刺点锐性切开蛛网膜和软脑膜、合理应用微电极记录、术中应用戴立体定向仪复查磁共振、延伸导线与刺激电极接头埋置和固定在枕骨骨槽内、脉冲发生器在锁骨上固定是本组手术技术的要点。结果本组术后1年、3年、5年UPDRS评分,关期改善率55.8%,53.4%,45.2%;开期改善率22.5%、23.2%、20.4%。并发症包括无症状性皮层出血、电极过深、皮肤破溃感染等。结论严谨和细致的外科操作,掌握手术技术要点,可提高DBS疗效,降低手术并发症。

Key points of deep brain stimulation surgery

Objective To potentially improve the curative effect and reduce the complications of deep brain stimulation （DBS） by summarizing the key points during the procedure of DB5 surgery. Methods 222 patients （116 male and 106 female） underwent DBS surgery in our department from March 2000 to October 2011, including 207 Parkinson ＇ s disease （ PD ） , 5 essential tremor and 10 dystonia. 335 electrodes were implanted in 3 different targets including subthalamic nucleus （ n = 325 ）, ventralis intermedius nucleus （ n = 14） and globus pallidus internus （n = 16）. The key points of the procedure were summarized as below： Sharp incised the arachnoid and piamater on a gyms, appropriate microelectrode recording, an intraoperative MRI scan with CRW stereotactic frame, implanted the connectors in the bone grooves on occipital bone and fixed the IPG on the clavicle bone. Results During the follow-up at 1 year, 3 year and 5 year, the improvement rate of Unified Parkinson＇ s disease rating scale part Ⅲ （ UPDRS BI ） at ＂off＂ state were 55.8% , 53.4% and 45.2% respectively, and at ＂on＂ state were 22.5% , 23.2% and 20.4% respectively. The complications included asymptomatic cortical hemorrhage, electrodes deeper than anticipation and postoperative incisional infections. Conclusion Meticulous mastering intraoperative surgical technique key points can improve the efficacy of DBS treatment and reduce the complications.