A Clinical Study of Patients with Primary Parkinson's Disease Undergoing Bilateral Deep Brain Stimulation (STN-DBS) Surgery in the Subthalamic Nucleus under General Anesthesia
目的 评估全身麻醉下丘脑底核（subthalamic nucleus, STN）脑深部电刺激术（deep brain stimulation, DBS）的疗效及安全性，为全麻DBS手术相关临床研究提供基础。 方法 以2019年1月–2021年12月在我院接受全麻DBS手术及局麻DBS手术的各30例原发性帕金森病患者为研究对象。所有患者均接受双侧丘脑底核电极植入，术中通过脑电双频指数（bispectral index, BIS）监测和控制麻醉深度，利用微电极记录（microelectrode recording, MER）双侧丘脑底核特征性放电，验证靶点位置。所有患者均一次性完成脑深部电极、延伸导线及刺激发生器（implantable pulse generator, IPG）植入，术后薄层CT扫描重建电极图像，验证电极植入精度。采用统一帕金森病评价量表第三部分（Unified Parkinson’s Disease Rating Scale-Ⅲ）评价手术前后运动症状改善情况，记录和分析术中MER结果以及手术相关并发症发生情况。 结果 所有患者均顺利完成植入手术，电极位置准确，全麻组及局麻组患者在手术前后的UPDRS-Ⅲ评分、药物剂量差异均无统计学意义。术后未发生颅内出血、脑梗塞及感染，5例患者出现暂时性精神行为异常，均在术后48 h内消失。 结论 全麻STN-DBS手术治疗帕金森病的术后疗效与传统局麻下电极植入手术疗效相当，在严格管理情况下，手术和麻醉相关并发症发生率低，并且能提高患者的手术舒适度。Abstract: Objective To assess the efficacy and safety of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) under general anesthesia and to provide the basis for clinical research related to DBS surgeries under general anesthesia. Methods A total of 60 patients with primary Parkinson's disease who underwent DBS surgery between January 2019 and December 2021at West China Hospital were enrolled for the study. Among them, 30 had the surgery while they were asleep, i.e., under general anesthesia, and 30, while they were awake, i.e., under local anesthesia. All the patients underwent bilateral STN-DBS surgery. Bispectral index (BIS) was used to monitor and control the depth of anesthesia. Microelectrode recording (MER) technology was used to record the characteristic signals of the bilateral subthalamic nuclei and verify their location during the operation. All patients completed the implantation of deep electrodes, connecting wires, and implantable stimulation generator (IPG) at one time. Postoperative thin-slice CT scans were done to reconstruct electrode images and to verify the accuracy of electrode implantation. The Unified Parkinson's Disease Rating Scale-Ⅲ (UPDRS-Ⅲ) was used to evaluate the preoperative vs. postoperative improvement in motor symptoms, and the results of intraoperative MER and the occurrence of surgery-related complications were documented and analyzed. Results All patients successfully completed the implantation surgery. The electrodes were accurately implanted at the right position and there was no significant difference between the general anesthesia group and the local anesthesia group in UPDRS-Ⅲ scores and medication dosage differences before and after the operation. No intracranial hemorrhage, cerebral infarction, or infection occurred after the operation, and 5 patients had temporary mental and behavioral abnormalities, which disappeared within 48 hours after the operation. Conclusion The postoperative therapeutic effect of STN-DBS surgery for primary Parkinson's disease under general anesthesia is comparable to that of the traditional STN-DBS surgery under local anesthesia. When the operation is performed under general anesthesia, the incidence of surgery and anesthesia-related complications is low if patients are managed strictly, and patients would also experience improved surgical comfort.
图 1 术后复查CT与术前MRI图像融合，验证电极植入位点
Figure 1. The fusion of postopꦺerative CT and preoperative MRI image to verify 💧the accuracy of electrode implantationA: The fusion of postoperative CT and preoperative MRI image; B: The actual position of the electrodes were reconstructed by the LEADDBS system through the preoperative MRI image and postoperative thin-slide CT. The silver parts are bilateral four contact electrodes; the orange parts are the subthalamic nuclei.
表 1 原发性PD的全麻患者和局麻患者的基本资料及围手术期主要结果对照
Table 1. The baseline characteristics and perioperative outcomes of patients with Parkinson’s disease under local anesthesia and general ane💮sthesia
Item Local anesthesia group (n=30) General anesthesia group (n=30) P Characteristics Age/yr. 59.7±9.0 62.9±6.6 0.119 Male/case (%) 18(60.0) 15 (50.0) 0.436 Duration of disease/years 9.9±4.2 9.1±3.2 0.410 Medication (mg/d) LEDDs before operation 773.5±44.5 856.8±52.0 0.229 LEDDs after operation 495.5±40.3 514.8±41.5 0.740 Preoperative UPDRS-Ⅲ score 43.6±10.4 40.8±11.1 0.313 Postoperative UPDRS-Ⅲ score After 3 months 18.2±4.7 19.0±3.5 0.495 After 6 months 18.2±4.4 18.7±3.6 0.678 LEDD: Levodopa equivalent daily doses; UPDRS-Ⅲ: Unified Parkinson’s disease rating scale-Ⅲ.
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