摘要
目的丘脑底核（STN）是帕金森病（PD）脑深部电刺激（DBS）治疗的主要靶点,使用多通道微电极记录可以准确地发现STN的感觉运动区,提高治疗精准度,提高DBS治疗效果;但多通道微电极记录的方法和风险目前介绍的比较少。现通过10例帕金森病STN-DBS手术中应用多通道微电极记录的方法,探讨多通道微电极记录的精准定位作用与风险。方法 2012年10月至2013年5月10例帕金森病患者在STNDBS手术中,应用多通道微电极记录（4~5个通道）,同步使用评分法记录,结合宏电极刺激结果,选择最终置入刺激电极的通道,比较术前预设的放置靶点与最终放置靶点的不同,测量通道的长度。结果不同的通道显示了不同的神经元放电模式以及其放电的强度与长度。比较最后电极植入通道与术前的预设中心靶点显示：左侧STN：放置中心位置6例,非中心4例,其中前方2例,外侧1例,内侧1例;右侧STN：中心位置5例,非中心5例,其中外侧4例,内侧1例,STN感觉运动区的通道长度：左侧STN感觉运动区信号长度为（4.85±1）mm（3~6 mm）,右侧STN感觉运动区信号长度为（4.83±0.7）mm（4~6 mm）。10例患者手术中未见出血并发症。结论 10例患者中选择预设靶点即中心靶点的比例只有50%~60%,有40%~50%的患者最终放置植入电极的位置与预设的靶点不同。多通道微电极记录可以覆盖整个STN,通过记录其电信号并分析比较,可以准确显示出STN的运动区域,选择最佳的通道植入电极,提高DBS治疗的效果;未见明显的出血并发症。因此多通道微电极记录是DBS手术中一种可以提高精准定位,同时也非常安全有效监测的方法。
Objective Subthalamic nucleus（ STN） was recognized as a major target for deep brain stimulation（ DBS） for Parkinson＇s disease（ PD）. Multichannel microelectrode recording could accurate identify the sensory-motor area of STN,improve the precision and treatment effect of DBS.However,the reports of the method and risk of multichannel microelectrode recording were rare. In10 patients with PD,multichannel microelectrode recording were used during STN-DBS surgeries,to explore the role and risk of multichannel microelectrode recording on the accurate location of lead implants for DBS. Methods From Oct,2012 to May,2013,in 10 patients with PD,multichannel microelectrode recording（ 4- 5 channels） were used during STN-DBS surgeries. Final lead implanted channel was chosen by synchronous scores and the result of macro electrode stimulation.We compared the differences between the predetermined location and the final location of lead implants,and measure the length of channels. Results Different channel recorded neuronal firing pattern,intensity and length of different neuron discharge. The final implanted channels and predet ermined central targets were compared. During left-STN location,central channel was chosen in 6sides,while non-central channel in 4 sides,including anterior channel in 2 sides（ 20%）; lateral channel in 1 side; medial channel in 1 side. During right-STN location,central channel was chosen in 5 sides,while non-central channel in 5 sides,including lateral channel in 4 side; medial channel in 1 side. The average length of the sensory-motor area of left STN activity was 4. 85 ± 1（ 3- 6 mm）,and the average length of the sensory-motor area of right STN activity was 4. 83 ± 0. 7（ 4- 6 mm）. There was on significant bleeding complication during total 10 surgeries. Conclusions Only in 50% ~ 60% patients,predetermined central targetz were chosen,while in 40% ~ 50% patients,the final implanted targets were inconsistent with the predetermined target. Multichannel microelectrode recording
作者
徐欣
凌至培
余新光
潘隆盛
崔志强
毛之奇
XU Xin LING Zhi-pei YU Xin-guang et al(Department of Neurosurgery, Chinese PLA General Hostpital ,Beijing 100853, China)
出处
《临床神经外科杂志》
CAS
2016年第6期401-406,共6页
Journal of Clinical Neurosurgery
基金
国家自然科学基金(81471745)
首都临床特色应用研究与成果推广(Z151100004015219)
关键词
多通道微电极记录
丘脑底核
帕金森病
脑深部电刺激
multichannel microelectrode recording
subthalamic nucleus
Parkinson＇s disease
deep brain stimulation
