震颤,运动迟缓,和僵硬是无法实现的运动症状,可以通过立体定向神经外科治疗来抑制,例如深部脑刺激(DBS)和消融手术(例如,丘脑切开术,苍白球切开术)。传统上,在清醒立体定向神经外科手术中,临床医生依靠临床评定量表对这些运动症状进行术中评估.然而,这些临床量表具有相对较高的评分者间变异性,并且依赖于有经验的评分者.因此,客观登记(例如,使用运动传感器)是术中评估震颤的合理扩展,运动迟缓,和刚性。本次范围审查的主要目的是提供清醒立体定向神经外科手术期间电子运动测量的概述。该协议基于PRISMA扩展范围审查。经过系统的数据库搜索(PubMed,Embase,和WebofScience),文章进行了相关性筛选。对一百三篇文章进行了详细的筛选。提取了关键临床和技术信息。纳入标准包括在局部麻醉下进行立体定向神经外科手术期间使用电子运动测量。包括23篇文章。这些研究有不同的目标,包括将基于传感器的结果测量与临床评分相关联,确定最佳DBS电极位置,并将临床评估转化为客观评估。这些研究在设备选择上高度不同,传感器位置,测量协议,设计,结果衡量标准,和数据分析。这篇综述表明,术中运动症状的定量仍然受到可变信号分析技术和缺乏标准化测量协议的限制。然而,电子运动测量可以补充视觉评估,并提供DBS电极和/或损伤的正确放置的客观确认。从长远来看,这可能有利于患者的预后,并在科学研究中提供可靠的预后指标.
Tremor, bradykinesia, and rigidity are incapacitating motor symptoms that can be suppressed with stereotactic neurosurgical treatment like deep brain stimulation (DBS) and ablative surgery (e.g., thalamotomy, pallidotomy). Traditionally, clinicians rely on clinical rating scales for intraoperative evaluation of these motor symptoms during awake stereotactic neurosurgery. However, these clinical scales have a relatively high inter-rater variability and rely on experienced raters. Therefore, objective registration (e.g., using movement sensors) is a reasonable extension for intraoperative assessment of tremor, bradykinesia, and rigidity. The main goal of this scoping
review is to provide an overview of electronic motor measurements during awake stereotactic neurosurgery. The protocol was based on the PRISMA extension for scoping reviews. After a systematic database search (PubMed, Embase, and Web of Science), articles were screened for relevance. Hundred-and-three articles were subject to detailed screening. Key clinical and technical information was extracted. The inclusion criteria encompassed use of electronic motor measurements during stereotactic neurosurgery performed under local anesthesia. Twenty-three articles were included. These studies had various objectives, including correlating sensor-based outcome measures to clinical scores, identifying optimal DBS electrode positions, and translating clinical assessments to objective assessments. The studies were highly heterogeneous in device choice, sensor location, measurement protocol, design, outcome measures, and data analysis. This
review shows that intraoperative quantification of motor symptoms is still limited by variable signal analysis techniques and lacking standardized measurement protocols. However, electronic motor measurements can complement visual evaluations and provide objective confirmation of correct placement of the DBS electrode and/or lesioning. On the long term, this might benefit patient outcomes and provide reliable outcome measures in scientific research.