目的 评价滑轨CT在帕金森病（PD）患者脑深部电刺激（DBS）手术中的临床应用效果。 方法 选择郑州大学第一附属医院神经外科自2019年5月至2023年5月采用DBS手术治疗的117例PD患者，其中采用局麻46例，全麻71例；73例患者行双侧丘脑底核（STN）DBS手术，43例患者行双侧苍白球内侧部（GPi）DBS手术，1例患者行右侧GPi DBS、左侧STN DBS手术。通过术前/术中滑轨CT图像与术前MRI图像融合，计算患者术前计划靶点与术中实际靶点的空间距离（如空间距离大于2 mm，表示电极位置偏移，及时调整电极位置）。比较不同麻醉、手术方式患者术前计划靶点与术中实际靶点空间距离的差异。 结果 117例PD患者手术均顺利完成，共植入234根电极。无因电极错位或疗效欠佳行二次手术的患者。CT扫描期间未发生麻醉脱管及机械碰撞，无颅内出血并发症。117例患者术前计划靶点与术中实际靶点的空间距离为（1。35±0。50） mm。术中4根电极的位置明显偏移，术中即刻调整电极位置，再次复查CT证实电极位置良好。全麻组和局麻组、STN组和GPi组患者双侧术前计划靶点与术中实际靶点空间距离的差异均无统计学意义（P>0。05）。 结论 滑轨CT操作简便、安全有效，有助于术中及时调整电极位置，避免二次手术及并发症的发生，从而提高DBS手术的安全性和疗效。 Objective To evaluate the clinical value of intraoperative sliding CT in deep brain stimulation (DBS) for Parkinson's disease (PD)。 Methods A total of 117 PD patients accepted DBS in Department of Neurosurgery， First Affiliated Hospital of Zhengzhou University from May 2019 to May 2023 were chosen 46 patients had local anesthesia and 71 had general anesthesia。 Bilateral subthalamic nucleus (STN) DBS was performed in 73 patients， bilateral medial globus pallidus (GPi) DBS was performed in 43 patients， and right GPi and left STN DBS was performed in 1 patient。 Preoperative/intraoperative sliding CT images and preoperative MRI images were fused to calculate the spatial distance between the preoperative planned target and actual target (adjusting electrode position timely in case of spatial distance greater than 2 mm [electrode displacement])。 Differences of spatial distance between preoperative planned target and actual target in patients accepted different types of anesthesia and surgical modalities were compared。 Results All 117 patients were successfully operated and 234 electrodes were implanted。 No patients needed a second operation for misalignment of electrodes or poor efficacy。 During CT scan， neither anesthesia extubation or mechanical collision nor intracranial hemorrhage complications occurred。 Spatial distance between the preoperative planned target and actual target was (1。35±0。50) mm in 117 patients。 Displacement was noted in 4 electrodes and immediately adjusted during the operation and CT re-examination confirmed good electrode position。 No statistical significance in spatial distance between the preoperative planned target and actual target was noted between the general anesthesia group and local anesthesia group， and between the STN group and GPi group (P>0。05)。 Conclusion Intraoperative sliding CT is simple， safe and effective， which helps to timely adjust the electrode position during operation， avoids second operation and complications， and improves the safety and efficacy of DBS。
Clinical value of intraoperative sliding CT in deep brain stimulation for Parkinson's disease
Objective To evaluate the clinical value of intraoperative sliding CT in deep brain stimulation (DBS) for Parkinson's disease (PD). Methods A total of 117 PD patients accepted DBS in Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University from May 2019 to May 2023 were chosen 46 patients had local anesthesia and 71 had general anesthesia. Bilateral subthalamic nucleus (STN) DBS was performed in 73 patients, bilateral medial globus pallidus (GPi) DBS was performed in 43 patients, and right GPi and left STN DBS was performed in 1 patient. Preoperative/intraoperative sliding CT images and preoperative MRI images were fused to calculate the spatial distance between the preoperative planned target and actual target (adjusting electrode position timely in case of spatial distance greater than 2 mm [electrode displacement]). Differences of spatial distance between preoperative planned target and actual target in patients accepted different types of anesthesia and surgical modalities were compared. Results All 117 patients were successfully operated and 234 electrodes were implanted. No patients needed a second operation for misalignment of electrodes or poor efficacy. During CT scan, neither anesthesia extubation or mechanical collision nor intracranial hemorrhage complications occurred. Spatial distance between the preoperative planned target and actual target was (1.35±0.50) mm in 117 patients. Displacement was noted in 4 electrodes and immediately adjusted during the operation and CT re-examination confirmed good electrode position. No statistical significance in spatial distance between the preoperative planned target and actual target was noted between the general anesthesia group and local anesthesia group, and between the STN group and GPi group (P>0.05). Conclusion Intraoperative sliding CT is simple, safe and effective, which helps to timely adjust the electrode position during operation, avoids second operation and complications, and improves the safety and efficacy of DBS.
Deep brain stimulationParkinson's diseaseSliding CT
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