目的:苍白球(GPI)已被证明是药物难治性帕金森病(PD)患者脑深部电刺激(DBS)治疗的有效手术靶点。神经外科医生确定苍白球(GP)内最大治疗获益区域的能力可能会改善这些患者的临床预后。这项研究的目的是确定GP内最佳的DBS治疗植入部位,以有效治疗PD患者。
方法:作者对2015年1月至2020年1月期间在其机构接受双侧GPDBS植入的56例患者进行了回顾性研究。每个植入的接触都是在解剖学上定位的。对患者进行至少6个月的刺激编程随访。作者根据统一帕金森病评定量表第三部分(UPDRSIII)的数据回顾了术前和术后6个月的临床结果,运动障碍评分,和左旋多巴等效日剂量(LEDD)。
结果:在植入的112根引线中,治疗阴极最常位于GPI外段(GPIe)和GP外段(GPE)之间的椎板(n=40).其他常见位置包括GPE(n=24),GPIe(n=15),以及GPI内段(GPIi)和GPIe之间的薄层(n=14)。在大多数患者(73%)中,使用单极编程配置。手术后6个月,UPDRSIII关闭药物(OFF)和刺激(ON)评分显着提高(z=-4.02,p<0.001),术后运动障碍ON评分(z=-4.08,p<0.001)和术后LEDD评分(z=-4.7,p<0.001)。
结论:尽管腹侧GP(苍白球切开术目标)已成为GPDBS的常用目标,更多的背外侧目标可能对神经调节策略更有效.本研究中对治疗性接触位置的评估表明,大多数患者使用的GPI和GPE之间的薄层是最佳的中枢刺激目标。这些信息应改善术前GP靶向。
The globus pallidus internus (GPI) has been demonstrated to be an effective surgical target for deep brain stimulation (DBS) treatment in patients with medication-refractory Parkinson\'s disease (PD). The ability of neurosurgeons to define the area of greatest therapeutic benefit within the globus pallidus (GP) may improve clinical outcomes in these patients. The objective of this study was to determine the best DBS therapeutic implantation site within the GP for effective treatment in PD patients.
The authors performed a retrospective review of 56 patients who underwent bilateral GP DBS implantation at their institution during the period from January 2015 to January 2020. Each implanted contact was anatomically localized. Patients were followed for stimulation programming for at least 6 months. The authors reviewed preoperative and 6-month postsurgery clinical outcomes based on data from the Unified Parkinson\'s Disease Rating Scale Part III (UPDRS III), dyskinesia scores, and levodopa equivalent daily dose (LEDD).
Of the 112 leads implanted, the therapeutic cathode was most frequently located in the lamina between the GPI external segment (GPIe) and the GP externus (GPE) (n = 40). Other common locations included the GPE (n = 24), the GPIe (n = 15), and the lamina between the GPI internal segment (GPIi) and the GPIe (n = 14). In the majority of patients (73%) a monopolar programming configuration was used. At 6 months postsurgery, UPDRS III off medications (OFF) and on stimulation (ON) scores significantly improved (z = -4.02, p < 0.001), as did postsurgery dyskinesia ON scores (z = -4.08, p < 0.001) and postsurgery LEDD (z = -4.7, p < 0.001).
Though the ventral GP (pallidotomy target) has been a commonly used target for GP DBS, a more dorsolateral target may be more effective for neuromodulation strategies. The assessment of therapeutic contact locations performed in this study showed that the lamina between GPI and GPE used in most patients is the optimal central stimulation target. This information should improve preoperative GP targeting.