帕金森病脑深部电刺激术后颅内积气对电极位置的影响  

The influence of pneumocephalus on electrode position following deep brain stimulation for Parkinson′s disease

作　　者：郑喆 蒋鸿杰 吴承瀚 朱周乐 罗巍[2] 田均[2] 朱君明 Zheng Zhe;Jiang Hongjie;Wu Chenghan;Zhu Zhoule;Luo Wei;Tian Jun;Zhu Junming(Department of Neurosurgery,the Secondary Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Neurology,the Secondary Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院神经外科,杭州310009 [2]浙江大学医学院附属第二医院神经内科,杭州310009

出　　处：《中华神经外科杂志》2024年第7期702-707,共6页Chinese Journal of Neurosurgery

摘　　要：目的探讨帕金森病脑深部电刺激(DBS)术后颅内积气对电极位置的影响规律。方法回顾性研究2021年5月至2022年10月于浙江大学医学院附属第二医院神经外科行双侧丘脑底核DBS的帕金森病患者的临床资料,共78例。患者均于术后早期(24 h内)和晚期(1个月)行头颅螺旋CT薄层扫描,通过图像的融合分析,计算颅内积气的体积、电极偏差(电极实际位置与计划靶点间的偏差值);并于前、后连合(AC-PC)下4 mm的轴位层面上计算术后早期与晚期的坐标差[X代表AC-PC旁开距离(外侧为正,内侧为负);Y代表AC-PC方向(前方为正,后方为负)],评估术后1个月内因颅内积气的吸收导致电极位置的偏移量,并分析颅内积气与坐标差间的相关性。结果78例患者术后早期整体颅内积气体积[M(Q1,Q3)]为1.08(0.22,3.02)cm^(3),其中左、右侧分别为0.24(0.00,0.94)cm^(3)、0.48(0.06,1.62)cm^(3);至术后晚期所有患者的颅内积气均完全吸收。术后早期左、右侧的电极偏差分别为(1.40±0.61)mm、(1.08±0.52)mm,术后晚期分别为(1.30±0.55)mm、(1.19±0.57)mm;术后早期与晚期同侧别比较,电极偏差的差异均无统计学意义(均P>0.05)。术后早期与晚期比较,电极位置的偏移量,左侧:ΔX=(0.41±0.52)mm,ΔY=1.00(0.70,1.50)mm;右侧:ΔX=(0.43±0.50)mm,ΔY=1.00(0.70,1.30)mm。相关性分析显示,左侧颅内积气与左侧X轴向(r=0.17,P=0.039)和Y轴向电极偏移量(r=0.24,P=0.003)均相关;右侧颅内积气与右侧X轴向电极偏移量(r=0.10,P=0.388)无关,但与Y轴向电极偏移量(r=0.44,P<0.001)相关。结论帕金森病患者DBS术后的颅内积气可能对电极位置产生影响,随着颅内积气的吸收和脑组织的回位,电极位置会向前和向外移位。Objective To investigate the influence of pneumocephalus on electrode position following deep brain stimulation for Parkinson′s disease.Methods A retrospective study was conducted on 78 patients with Parkinson′s disease who underwent bilateral deep brain stimulation of the subthalamic nucleus between May 2021 and October 2022 at the Department of Neurosurgery,the Secondary Affiliated Hospital,Zhejiang University School of Medicine.Thin-slice CT scan was performed in the early(within 1 day)and late(1 month)postoperative periods respectively.The volume of pneumocephalus and the deviation between the electrode and the target were calculated.The coordinate difference between the early and late postoperative periods was calculated at an axial level 4 mm below the anterior and posterior commissure.X represented the lateral or medial distance to the AC(anterior commissure)-PC(posterior commissure)line(positive for the lateral and negative for the medial);Y represented the distance in the direction of AC-PC line(positive for the anterior and negative for the posterior).The deviation of the electrode position caused by the absorption of intracranial pneumocystis within 1 month after surgery was evaluated,and the correlation between intracranial pneumocephalus and the coordinate difference was analyzed.Results Median volume of pneumocephalus for a cohort of 78 patients was measured to be 1.08(0.22,3.02)cm^(3) in the early postoperative period,the median volume of pneumocephalus for the left and right sides were observed to be 0.24(0.00,0.94)cm^(3) and 0.48(0.06,1.62)cm^(3),respectively.There was no significant difference on the left(1.40±0.61 mm vs.1.30±0.55 mm,P=0.299)or the right(1.08±0.52 mm vs.1.19±0.57 mm,P=0.190)deviations of electrodes from the intended target between early and late postoperative periods.The difference in electrode coordinates between late and early postoperative was as follows:left sideΔX=0.41±0.52 mm,ΔY=1.00(0.70,1.50)mm;right sideΔX=0.43±0.50 mm,ΔY=1.00(0.70,1.30)mm.The left intracr

关 键 词：帕金森病 深部脑刺激法 颅内积气 电极偏差 

分 类 号：R651.1[医药卫生—外科学]