经颅超声在STN-DBS电极植入术靶点定位中的应用  

Application of transcranial sonography to guide localization of electrode implantation during STN-DBS for patients with movement disorder

作　　者：阿不都拉·艾沙 魏汝锐 王霞[2] 郝梦蝶 史有才 ABUDULA Aisha;WEI Rui-rui;WANG Xia;HAO Meng-die;SHI You-cai(Department of Neurosurgery,Second Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)

机构地区：[1]新疆医科大学第二附属医院神经外科,乌鲁木齐830000 [2]新疆医科大学第二附属医院超声科,乌鲁木齐830000

出　　处：《中国临床神经外科杂志》2022年第8期650-652,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的 探讨经颅超声引导技术在丘脑底核(STN)脑深部电刺激术(DBS)中植入电极精准定位中的应用价值。方法回顾性分析2020年5月至2021年5月利用经颅超声引导技术辅助丘脑底核(subthalamic nucleus STN)-DBS治疗的11例运动障碍性疾病的临床资料。在接受STN-DBS电极植入侧有合适颞骨窗时经颅超声对电极位置进行监测和测量。结果 11例中,帕金森病9例,肌张力障碍2例。颞部耳前骨窗超声能够观察到植入电极的高强回声点状信号,可以观察到中脑周围与电极植入相关解剖结构,以及与植入电极的关系。术后随访4~24个月;9例帕金森病药物“关”状态统一帕金森病评定量表评分改善率为60.0%;药物“开”状态改善率为44.0%;2例肌张力障碍病人肌张力障碍运动评分量表评分改善率为40%、80%;随访期间,2例发生构音障碍,经程控后改善;1例出现癫痫发作;无出血等并发症。结论 经颅超声能够显示黑质以及植入电极的高回声信号,是确定脑深部刺激电极或黑质内外正确位置的一种操作方便的辅助技术。Objective To investigate the application value of transcranial sonography-guided technique in precisely locating the implanted electrodes during subthalamic nucleus(STN) deep brain stimulation(DBS).Methods The clinical data of 11 patients with movement disorder who received STN-DBS under guidance of transcranial sonography from May 2020 to May 2021 were retrospectively analyzed.Electrode position was monitored and measured by transcranial sonography with a suitable temporal bone window on the side receiving the STN-DBS electrode implantation.Results Of 11 patients with movement disorder,9 patients suffered from Parkinson’s disease and 2 dystonia.The sonography via temporal preauricular bone window showed high-intensity echogenic point-like signals of the implanted electrodes,and the anatomical structures around the midbrain related to the electrode implantation and the relationship with the implanted electrodes.The postoperative follow-up ranged from 4 months to 24 months.The improvement rate of the Unified Parkinson’s Disease Rating Scale score was 60.0% in 9 patients with Parkinson’s disease under drug-off state,and it was 44.0% under drug-on state.The improvement rates of dystonia motor scale score of 2 patients with dystonia were 40% and 80%,respevtively.During the follow-up,dysarthria occurred in 2 patients,and epileptic seizure in 1.There was no intracranial bleeding.Conclusions Transcranial sonography can obaerve the hyperechoic signals of the substantia nigra and implanted electrodes.It is a convenient auxiliary technique to determine the correct positions of the electrodes and the substantia nigra during STN-DBS.

关 键 词：运动障碍疾病 经颅超声 脑深部电刺激术 丘脑底核 黑质 

分 类 号：R742[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]