全麻双谱指数监测下帕金森病深部脑刺激术中丘脑下核靶位分析

Q4 Medicine

中华神经外科杂志 Pub Date : 2019-10-28 DOI:10.3760/CMA.J.ISSN.1001-2346.2019.10.009

Jiyuan Liu, Hong-Jie Lyu, Rurong Tang, Hongmei Yu, Yan Ren, Shao-Wu Ou, L. Pei, Yun-jie Wang, Jun Wang

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引用次数: 0

摘要

目的探讨电生理定位STN靶点在全身麻醉下深部脑刺激(DBS)联合双谱指数(BIS)监测治疗帕金森病(PD)中的可行性。方法回顾性分析2017年9月至2019年5月在中国医科大学第一医院神经外科行双侧STN-DBS治疗的22例PD患者的资料。所有患者均在全身麻醉下进行BIS监测完成手术。所有的STN核都是基于微电极记录(MER)定位的。术后MRI与术前MRI融合评估电极植入的准确性。结果在睡眠DBS过程中，44侧脑电刺激均记录了STN感觉-运动区的放电。当BIS值维持在70以上时，植入微电极，记录40侧STN电生理信号。BIS值维持在30 ~ 60之间时，其余4侧放电频率和幅度仅为BIS值维持在70以上时的50%左右。STN电生理长度右侧为3.5 ~ 7.5(5.2±0.9)mm，左侧为3.5 ~ 7.5(5.5±1.0)mm。植入颅电极后，BIS值≥80时，18例患者能完成临床症状及副作用刺激试验，4例患者只能完成运动副作用试验。术后MRI显示电极靶均位于STN核内，右侧径向误差为(1.10±0.45)mm，左侧径向误差为(1.24±0.56)mm。无颅内出血、感染等并发症发生。结论睡眠STN- dbs术中，在BIS(≥70)监测下，MER可记录到清晰、典型的STN放电。目标定位似乎很准确。关键词:帕金森病;麻醉,一般;脑深部电刺激;双频谱指数;微电极记录

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Analysis of intra-operative target location of subthalamic nucleus in deep brain stimulation surgery for Parkinson′s disease with bispectral index monitoring under general anesthesia

Objective To explore the feasibility of using electrophysiology to locate STN targets in the treatment of Parkinson′s disease (PD) by deep brain stimulation (DBS) with bispectral index (BIS) monitoring under general anesthesia. Methods The data of 22 PD patients treated by bilateral STN-DBS at Department of Neurosurgery, the First Hospital of China Medical University from September 2017 to May 2019 were retrospectively analyzed. All patients completed surgery with BIS monitoring under general anesthesia. All STN nuclei were located based on microelectrode recording (MER). Postoperative MRI was fused with preoperative MRI to evaluate the accuracy of electrode implantation. Results The discharge in the sensory-motor area of STN were recorded by MER in all 44 sides during asleep DBS. Microelectrodes were implanted and STN electrophysiological signals were recorded for 40 sides when BIS value was maintained above 70. For the other 4 sides when BIS value was maintained between 30 and 60, and the discharge frequency and amplitude were only about 50% of those when BIS value was maintained above 70. The electrophysiological length of STN was 3.5-7.5(5.2±0.9) mm on the right side and 3.5-7.5(5.5±1.0)mm on the left side, respectively. After intracranial electrode was implanted and when BIS value ≥80, 18 patients could complete the stimulation test for clinical symptoms and side effects, and 4 patients could only complete the test for motor side effects. Postoperative MRI showed that all electrode targets were located in STN nucleus, and the radial error was (1.10±0.45)mm on the right side and (1.24±0.56)mm on the left side. No intracranial hemorrhage, infection or other complications occurred. Conclusions During the surgery of asleep STN-DBS, clear and typical STN discharge could be recorded in MER with BIS (≥70) monitoring. The target localization seems accurate. Key words: Parkinson disease; Anesthesia, general; Deep brain stimulation; Bispectral index; Microelectrode recording

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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.