术后早期的定向脑深部刺激导线旋转。

Neurosurgery practice Pub Date : 2024-07-19 eCollection Date: 2024-09-01 DOI:10.1227/neuprac.0000000000000102
Huy Q Dang, Gabriel Reyes, Ethan Devara, Nisha Giridharan, Anthony K Allam, Garrett P Banks, Ashwin Viswanathan, Ben Shofty, Sameer A Sheth
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引用次数: 0

摘要

背景和目的:定向脑深部刺激(DBS)可以通过使用分段导联进行电流控制来优化治疗。确定引线的旋转方向对指导规划决策至关重要。通常在种植期间或种植后立即评估取向,但在接下来的几周内不太了解铅的旋转程度。我们的目的是测量DBS导联在手术后最初几周内旋转方向改变的程度。方法:我们回顾性地回顾了在我们机构植入分段DBS导线的患者的临床记录。所有纳入的患者术后至少进行一次CT扫描(CT1),至少一周后再进行一次CT扫描(CT2)。我们评估了CT1和CT2的导联旋转方向角,并计算了扫描之间的旋转变化程度。我们还通过计算CT1-CT2延迟和导联旋转程度之间的相关性来评估扫描间隔时间的任何影响。结果:我们共评估了38例患者的75个DBS导联定位。CT1和CT2的平均导联取向变化为8.6°(中位数为2.9°,范围为0.11-168.2°)。只有8%的患者(3/38)被发现有明显的方向改变(bbb30°);然而,当它发生时,它发生在双方。CT1-CT2潜伏期与导联旋转无相关性(r(74) = 0.04, P = 0.73)。结论:我们的研究发现,在手术后的最初几周内发生导联取向的变化是罕见的。因此,对于大多数患者,术后立即CT足以确定临床规划的取向角度。然而,如果发现编程困难,重复CT扫描可能对少数患者有益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Directional Deep Brain Stimulation Lead Rotation in the Early Postoperative Period.

Background and objectives: Directional deep brain stimulation (DBS) enables treatment optimization by current steering using segmented leads. Identification of the lead's rotational orientation is critical to guide programming decisions. Orientation is often assessed during or immediately after implant, but the degree of lead rotation in the following weeks is not well appreciated. Our objective was to measure the degree of DBS lead rotational orientation changes within the first few weeks after surgery.

Methods: We retrospectively reviewed the clinical records of patients who were implanted with segmented DBS leads at our institution. All included patients had at least 1 immediate postoperative computed tomography (CT) (CT1) and another CT at least 1 week later (CT2). We assessed lead rotational orientation angles on CT1 and CT2 and calculated the degrees of rotation change between the scans. We also assessed for any effect of the time interval between scans by calculating the correlation between CT1-CT2 latency and degrees of lead rotation.

Results: We assessed a total of 75 DBS lead orientations for 38 patients. The average change in lead orientation between CT1 and CT2 was 8.6° (median = 2.9°, range = 0.11-168.2°). Only 8 percent of patients (3/38) were found to have a significant change in orientation (>30°); however, when it occurred, it occurred bilaterally. There was no correlation between CT1-CT2 latency and lead rotation (r(74) = 0.04, P = .73).

Conclusion: Our study finds that changes in lead orientation occurring over the first few weeks after surgery are rare. Thus, for most patients, the immediate postoperative CT is adequate for determining the orientation angles for clinical programming. However, if programming is found to be difficult, a repeat CT scan could be beneficial for a minority of patients.

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