颅内积气对神经外科手术机器人辅助脑深部电刺激治疗帕金森病的影响  

Effects of intracranial air on neurosurgical robot-assisted deep brain stimulation in the treatment of Parkinson's disease

作　　者：巩顺 陶英群 梁国标 王诗邈 雷伟 吴伟东 王强 沙蓉 黄勃翰 袁立佳 Gong Shun;Tao Yingqun;Liang Guobiao;Wang Shimiao;Lei Wei;Wu Weidong;Wang Qiang;Sha Rong;Huang Bohan;Yuan Lijia(Department of Neurosurgery,the General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]解放军北部战区总医院神经外科,沈阳110016

出　　处：《中华神经外科杂志》2024年第1期39-45,共7页Chinese Journal of Neurosurgery

基　　金：辽宁省应用基础研究计划(2022JH2/101300055)。

摘　　要：目的探讨颅内积气(ICA)对神经外科手术机器人辅助脑深部电刺激(DBS)治疗帕金森病(PD)的电极植入精度及临床疗效的影响。方法回顾性分析解放军北部战区总医院神经外科2017年2月至2022年5月接受双侧神经外科手术机器人辅助DBS治疗292例PD患者的临床资料,其中局部麻醉95例,全身麻醉197例;以双侧丘脑底核(STN)为靶点植入电极193例,双侧苍白球内侧部(GPi)为靶点99例。通过术后融合CT图像测量分析术后2h、1周的电极束移位、电极头端偏移情况并计算ICA体积;根据ICA体积分为<10cm^(3),10~25cm^(3),>25cm^(3)三个亚组,分析三个亚组在术后2h、1周(分别为188、71、33例),STN靶点(分别为123、48、22例)及GPi靶点(分别为65、23、11例)电极植入精度的组间差异,随访12个月时统一PD评定量表第三部分(UPDRS-Ⅲ)评分改善率、不同靶点程控电压及预后的组间差异。结果292例患者手术均顺利完成,术后均无颅内感染、出血等并发症发生。所有患者的ICA体积为(7.3±0.6)cm^(3),其中第一侧与第二侧、男性与女性、GPi与STN靶点患者的ICA体积差异均无统计学意义(均P>0.05);而局部麻醉与全身麻醉患者的ICA体积差异具有统计学意义(t=6.12,P<0.001)。电极束移位特征模型显示,电极束在术后2h向后弯曲,术后1周恢复笔直状态。术后2h、1周电极头端第一侧与第二侧在X、Y轴偏移距离的差异均无统计学意义(均P>0.05),术后2h、1周电极头端同侧在X轴偏移距离的差异均无统计学意义(均P>0.05),而在Y轴偏移距离差异均具有统计学意义(均P<0.001)。292例患者的电极植入精度为(0.75±0.35)mm,术后2h、1周,三个亚组及其在STN靶点,GPi靶点电极植入精度的组间差异均具有统计学意义(均P<0.001)。其中,ICA>25cm^(3)亚组中GPi靶点电极植入精度的增加幅度值(术后2h与术后1周的差值)较STN靶点高,差异具有统计学意义[(0.46±0.21)mm对比(0.28±0.18)mm,t=2.5Objective To explore the impact of intracranial air(ICA)on the electrode implantation accuracy and clinical efficacy of neurosurgical robot-assisted deep brain stimulation(DBS)in the treatment of Parkinson's disease(PD).Methods A retrospective analysis was conducted on the clinical data of 292 PD patients who underwent bilateral neurosurgical robot-assisted DBS surgery at the Department of Neurosurgery,the General Hospital of Northern Theater Command from February 2017 to May 2022,including 95 cases of local anesthesia and 197 cases of general anesthesia.There were 193 cases of electrodes implanted into bilateral subthalamic nucleus(STN)and 99 cases into the bilateral globus pallidus interna(GPi).The postoperative fused CT images were used to measure and analyze the electrode displacement and electrode tip excursion 2 hours and 1 week after surgery.We then calculated the ICA volumes,which were divided into three categories:<10 cm^(3),10-25 cm^(3),and>25 cm^(3)subgroups.The differences in electrode implantation accuracy of those tree categories were analyzed at 2 hours and 1 week after surgery(number of cases:188,71,33,respectively),for STN target(number of cases:123,48,22,respectively)and for GPi target(number of cases:65,23,and 11,respectively).The improvement rate of the Unified PD Rating Scale Part Ⅲ(UPDRS-Ⅲ)score at 12-month follow-up and the differences in programming voltages and outcomes at different targets were analyzed.Results The operations of all 292 patients were successfully completed,and there were no postoperative complications such as intracranial infection or bleeding.The ICA volume of all patients was 7.3±0.6 cm^(3),and there was no statistically significant difference in ICA volume between the first side and the second side,men and women,GPi and STN target patients(all P>0.05).The difference in ICA volume between patients under local anesthesia and general anesthesia was statistically significant(t=6.12,P<0.001).The electrode displacement characteristic model showed that the electrode ben

关 键 词：帕金森病 深部脑刺激法 颅内积气 治疗结果 机器人 电极精度 

分 类 号：R651.1[医药卫生—外科学]