全身麻醉脑电双频指数监测下丘脑底核脑深部电刺激术治疗帕金森病靶点定位分析  

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

作　　者：刘济源[1] 吕红 汤如荣[3] 禹红梅[2] 任艳[2] 欧绍武[1] 裴凌[3] 王运杰[1] 王军[1] Liu Jiyuan;Lyu Hong;Tang Rurong;Yu Hongmei;Ren Yan;Ou Shaowu;Pei Ling;Wang Yunjie;Wang Jun(Department of Neurosurgery,the First Hospital of China Medical University,Shenyang 110001,China;Department of Neurology,the First Hospital of China Medical University,Shenyang 110001,China;Department of Anesthesiology,the First Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院神经外科,沈阳110001 [2]中国医科大学附属第一医院神经内科,沈阳110001 [3]中国医科大学附属第一医院麻醉科,沈阳110001

出　　处：《中华神经外科杂志》2019年第10期1011-1014,共4页Chinese Journal of Neurosurgery

基　　金：国家重点研发计划(2016YFC0105900)。

摘　　要：目的探讨全身麻醉脑电双频指数(BIS)监测下脑深部电刺激术(DBS)治疗帕金森病(PD)术中应用电生理学定位STN靶点的可行性。方法回顾性分析2017年9月至2019年5月中国医科大学附属第一医院神经外科行双侧STN-DBS的PD患者的临床资料,共22例。所有患者均在全身麻醉BIS监测下完成手术,均采用微电极纪录(MER)定位STN核团,术后复查MRI并与术前MRI融合,评估电极植入情况。结果22例患者44侧均可记录到STN感觉-运动区的电生理信号。其中40侧在BIS值≥70时植入微电极,均记录到清晰、典型的STN电生理信号;4侧在BIS值30~60时植入微电极,均记录到STN电生理信号,但其放电频率、幅度仅达到BIS值≥70时的50%左右。其中右侧STN电生理信号长度为3.5~7.5(5.2±0.9)mm,左侧为3.5~7.5(5.5±1.0)mm。术后MRI显示所有电极靶点位置均在STN核团内。在植入颅内电极后,当BIS值≥80时,18例患者可较好地配合完成对临床症状和不良作用的刺激测试,4例仅可完成对运动功能不良作用的测试。术后检查显示,右侧电极靶点径向误差为(1.10±0.45)mm,左侧电极靶点径向误差为(1.24±0.56)mm;无颅内出血、感染等并发症。结论BIS监测下全身麻醉STN-DBS治疗PD,MER均可记录到STN电生理信号;电极靶点植入准确。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.

关 键 词：帕金森病 麻醉 全身 深部脑刺激法 脑电双频指数 微电极记录 

分 类 号：R61[医药卫生—外科学]