Effects of intracranial air on neurosurgical robot-assisted deep brain stimulation in the treatment of Parkinson's disease
Objective 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 cm3,10-25 cm3,and＞25 cm3 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 cm3,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 bent backward 2 hours after surgery and returned to straightness 1 week after surgery.There was no statistically significant difference in the X-axis and Y-axis offset distance between the first and second sides of the electrode tip 2 hours and 1 week after surgery(all P＞0.05).There was no difference in the X-axis offset distance on the same side(both P＞0.05),and the differences in Y-axis offset distance were all statistically significant(both P＜0.001).The electrode implantation accuracy of 292 patients was 0.75±0.35 mm.There were statistically significant differences in the electrode implantation accuracy of the STN target and GPi target among the three subgroups at 2 hour and 1 week after surgery(all P＜0.001).Among them,the increase in accuracy of GPi target electrode implantation(the difference value between 2 hours and 1 week after surgery)in the ICA＞25 cm3 subgroup was higher than that of the STN target,and the difference was statistically significant(0.46±0.21 mm vs.0.28±0.18 mm,t=2.56,P=0.016).All 292 patients received clinical follow-up 12 months after surgery.The UPDRS-Ⅲ score improvement rate was 59.3％±17.9％.The postoperative programmed voltage was 2.42±0.40 V for the STN target and 3.88± 0.56 V for the GPi target.There was no statistical significance in the UPDRS-Ⅲ score improvement rate or the programmed voltage for the STN target among the three subgroups(all P＞0.05),while the difference in the programmed voltage for the GPi target was statistically significant(Z=17.64,P＜0.001).During the programming process,72 patients experienced adverse reactions such as dizziness and dyskinesia,among which the ICA＞25 cm3 subgroup accounted for the highest proportion(44.4％,32/72).After treatments such as programming adjustment of voltage parameters,the symptoms improved.Conclusions ICA will cause electrode deformation and electrode tip displacement after neurosurgical robot-assisted DBS treatment of PD,affecting the electrode implantation accuracy.When the ICA volume is＞25 cm3,it is difficult to restore the electrode implantation accuracy when selecting the GPi as target.Although the target of GPi can be selected to improve the motor symptoms of PD patients,the voltage required for programming is higher and there might be more adverse reactions.
万方数据
维普
