背景:脑深部电刺激是帕金森病(PD)的常用治疗方法。尽管在精心挑选的患者中有很强的疗效,可能发生并发症。术中微电极记录(MER)可以通过提高引线准确性来提高功效。然而,MER是否会增加出血风险存在争议.
目的:提供全面的系统评价和荟萃分析,报告PD脑深部电刺激并发症的发生率。我们还询问了出血和MER之间的关联。
方法:在查询Pubmed,Embase,和Cochrane数据库。所有纳入的研究均为随机对照试验和5名或更多患者的前瞻性病例系列。主要结果包括总体修订率,感染,铅错位,手术部位和伤口并发症,硬件相关的并发症,和癫痫。次要结果是MER道数量与出血率之间的关系。
结果:262篇文章,21,261例患者被纳入分析。平均随访时间为25.8个月(范围0-133)。并发症发生率为:修订4.9%,感染4.2%,铅错位3.3%,手术部位并发症2.8%,出血2.4%,硬件相关并发症2.4%,癫痫发作1.9%。虽然单道MER不会增加出血率(比值比,3.49;P=0.29),每个额外的轨道都有显着的非线性增加。
结论:感染和导线错位是最常见的并发症。出血风险随着一个以上的MER轨道而增加。这些结果突出了平衡手术准确性和围手术期风险的挑战。
Deep brain stimulation is a common treatment for Parkinson\'s disease (PD). Despite strong efficacy in well-selected patients, complications can occur. Intraoperative micro-electrode recording (MER) can enhance efficacy by improving lead accuracy. However, there is controversy as to whether MER increases risk of hemorrhage.
To provide a comprehensive systematic
review and meta-analysis reporting complication rates from deep brain stimulation in PD. We also interrogate the association between hemorrhage and MER.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were implemented while querying the Pubmed, Embase, and Cochrane databases. All included studies were randomized controlled trials and prospective case series with 5 or more patients. Primary outcomes included rates of overall revision, infection, lead malposition, surgical site and wound complications, hardware-related complications, and seizure. The secondary outcome was the relationship between number of MER tracks and hemorrhage rate.
262 articles with 21,261 patients were included in the analysis. Mean follow-up was 25.8 months (range 0-133). Complication rates were: revision 4.9%, infection 4.2%, lead malposition 3.3%, surgical site complications 2.8%, hemorrhage 2.4%, hardware-related complications 2.4%, and seizure 1.9%. While hemorrhage rate did not increase with single-track MER (odds ratio, 3.49; P = 0.29), there was a significant non-linear increase with each additional track.
Infection and lead malposition were the most common complications. Hemorrhage risk increases with more than one MER track. These results highlight the challenge of balancing surgical accuracy and perioperative risk.