Outcomes of deep brain stimulation lead revision surgeries for Parkinson’s disease

Q4 Medicine

中华神经外科杂志 Pub Date : 2019-11-28 DOI:10.3760/CMA.J.ISSN.1001-2346.2019.11.012

Ma Yu, Zhou Rongsong, Miao Suhua, Yang Yuan

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引用次数: 0

Abstract

Objective To study the outcomes of the revision surgeries correcting electrode malposition in deep brain stimulation (DBS) for Parkinson’s disease (PD). Methods A total of 18 PD patients were enrolled who underwent lead revision surgeries due to subthalamic nucleus (STN) DBS lead malposition at Neuromodulation Center, Department of Neurosurgery, Tsinghua University Yuquan Hospital between September 2013 and May 2018. Changes in UPDRS-III scores on and off medication were analyzed at 1 month and 6 months postoperatively compared to those before surgery. MR images were also collected to analyze the lead location change. Results Among the 18 patients, 14 had bilateral lead revision and 4 had unilateral revision. A total of 32 leads were revised, among which 25 were reimplanted and the other 7 were repositioned without reimplantation. Off medication, the average UPDRS-Ⅲ scores before and 1 month and 6 months after surgery were 44.0±10.5, 22.4±7.4 and 25.3±7.7 respectively. On medication, those were 27.3±9.1, 16.7±8.7 and 20.3±8.3 respectively. The analysis of variance and comparisons between groups showed that the on and off medication scores were significantly reduced after the revision surgery (P<0.05). The off medication score at 6 months was averagely improved by (40.7±4.7)%(5.9-79.5%). The average distance between pre-implantation and post-implantation lead locations on the plane 3.5 mm below AC (anterior commissure)-PC (posterior commissure) was (2.8±1.0) mm(1.2-4.5 mm). No adverse events such as hemorrhage or infection were observed after surgery. Conclusion Lead revision surgery could safely and effectively remedy the suboptimal outcomes due to electrode malposition in STN-DBS for PD patients. Key words: Parkinson disease; Deep brain stimulation; Subthalamic nucleus; Electrode malposition; Revision surgery

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脑深部电刺激导致帕金森病翻修手术的结果

目的探讨脑深部刺激电极错位矫正术治疗帕金森病的疗效。方法2013年9月至2018年5月，在清华大学玉泉医院神经外科神经调控中心，对18例因丘脑底核（STN）DBS导线错位而接受导线矫正手术的帕金森病患者进行研究。与手术前相比，分析了术后1个月和6个月用药前后UPDRS-III评分的变化。还收集了MR图像以分析导线位置的变化。结果18例患者中，14例行双侧导线翻修术，4例行单侧导线翻修术。共修正了32条导线，其中25条重新植入，另外7条在没有重新植入的情况下重新定位。术前、术后1个月和6个月的平均UPDRS-Ⅲ评分分别为44.0±10.5、22.4±7.4和25.3±7.7。用药后分别为27.3±9.1、16.7±8.7和20.3±8.3。方差分析和组间比较显示，翻修手术后用药前后评分显著降低（P<0.05），6个月用药后评分平均提高（40.7±4.7）%（5.9-79.5%），植入前和植入后导线位置在AC（前连合）-PC下3.5mm平面上的平均距离（后连合）为（2.8±1.0）mm（1.2-4.5 mm）。术后未观察到出血或感染等不良事件。结论导线翻修术可以安全有效地治疗因STN-DBS电极错位而导致的PD患者不良结局。关键词：帕金森病；脑深部刺激；丘脑下核；电极错位；翻修手术

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来源期刊

中华神经外科杂志 Medicine-Surgery

CiteScore

0.10

自引率

0.00%

发文量

10706

期刊介绍： Chinese Journal of Neurosurgery is one of the series of journals organized by the Chinese Medical Association under the supervision of the China Association for Science and Technology. The journal is aimed at neurosurgeons and related researchers, and reports on the leading scientific research results and clinical experience in the field of neurosurgery, as well as the basic theoretical research closely related to neurosurgery.Chinese Journal of Neurosurgery has been included in many famous domestic search organizations, such as China Knowledge Resources Database, China Biomedical Journal Citation Database, Chinese Biomedical Journal Literature Database, China Science Citation Database, China Biomedical Literature Database, China Science and Technology Paper Citation Statistical Analysis Database, and China Science and Technology Journal Full Text Database, Wanfang Data Database of Medical Journals, etc.