PDF(Pubmed)
Abstract：
UNASSIGNED: We present the case of a patient who developed intra-operative pneumocephalus during left globus pallidus internus deep brain stimulation (DBS) placement for Parkinson\'s disease (PD). Microelectrode recording (MER) revealed that we were anterior and lateral to the intended target.
UNASSIGNED: Clinically, we suspected brain shift from pneumocephalus. Removal of the guide-tube for readjustment of the brain target would have resulted in the introduction of movement resulting from brain shift and from displacement from the planned trajectory.
UNASSIGNED: We elected to leave the guide-tube cannula in place and to pass the final DBS lead into a channel that was located posterior-medially from the center microelectrode pass.
UNASSIGNED: Surgical techniques which can be employed to minimize brain shift in the operating room setting are critical for reduction in variation of the final DBS lead placement. Pneumocephalus after dural opening is one potential cause of brain shift. The recognition that the removal of a guide-tube cannula could worsen brain shift creates an opportunity for an intraoperative team to maintain the advantage of the \'fork\' in the brain provided by the initial procedure\'s requirement of guide-tube placement.
UNASSIGNED: Clinically, we suspected brain shift from pneumocephalus. Removal of the guide-tube for readjustment of the brain target would have resulted in the introduction of movement resulting from brain shift and from displacement from the planned trajectory.
UNASSIGNED: We elected to leave the guide-tube cannula in place and to pass the final DBS lead into a channel that was located posterior-medially from the center microelectrode pass.
UNASSIGNED: Surgical techniques which can be employed to minimize brain shift in the operating room setting are critical for reduction in variation of the final DBS lead placement. Pneumocephalus after dural opening is one potential cause of brain shift. The recognition that the removal of a guide-tube cannula could worsen brain shift creates an opportunity for an intraoperative team to maintain the advantage of the \'fork\' in the brain provided by the initial procedure\'s requirement of guide-tube placement.
摘要：
■我们介绍了一例患者，该患者在帕金森氏病（PD）的左苍白球内深部脑刺激（DBS）放置过程中出现了术中气颅。微电极记录（MER）显示我们在预期目标的前方和外侧。
■临床，我们怀疑脑转移是由脑外伤引起的.移除用于重新调整大脑目标的引导管会导致引入由大脑移位和从计划轨迹的位移引起的运动。
■我们选择将导管套管留在适当的位置，并将最终的DBS导线穿过位于中央微电极通道的后内侧的通道。
■可用于在手术室环境中最小化脑移位的手术技术对于减少最终DBS导线放置的变化至关重要。硬脑膜开放后的气肿是脑移位的潜在原因之一。认识到移除导管插管可能会加剧大脑移位，这为术中团队提供了一个机会，以保持最初手术要求的导管放置所提供的大脑中的“叉”的优势。
■临床，我们怀疑脑转移是由脑外伤引起的.移除用于重新调整大脑目标的引导管会导致引入由大脑移位和从计划轨迹的位移引起的运动。
■我们选择将导管套管留在适当的位置，并将最终的DBS导线穿过位于中央微电极通道的后内侧的通道。
■可用于在手术室环境中最小化脑移位的手术技术对于减少最终DBS导线放置的变化至关重要。硬脑膜开放后的气肿是脑移位的潜在原因之一。认识到移除导管插管可能会加剧大脑移位，这为术中团队提供了一个机会，以保持最初手术要求的导管放置所提供的大脑中的“叉”的优势。
