| ObjectivesTo observe the clinical efficacy of bilateral STN-DBS in the treatment of PD, to explore its surgical skills, aimed at improving the accuracy of stimulation of electrode implantation and reduce the incidence of complications.MethodsWe retrospectively analyzed the clinical data and surgical methods of 56 patients w:ith PD who underwent bilateral STN-DBS treatment from minimally invasive neurosurgery at the First Affiliated Hospital of Kunming Medical University from March 2015 to March 2017. The difference of the UPDRS-? score of not taking medicine before surgery,the UPDRS-? score not taking medicine after surgery,the UPDRS-? score taking medicine and the dosage of drug in the 56 patients with PD were compared with those of PD patients. The clinical efficacy of bilateral STN-DBS in the treatment of PD was observed. To observe the effect of different methods on the accuracy of intraoperative stimulation of electrodes.For example,intraoperative MER,intraoperative micro-damage effect observation, intraoperative stimulation effect observation, intraoperative imaging examination and other methods; Statistical analysis was used to compare the incidence of intraoperative puncture and the incidence of intracranial gas in the subarachnoid occlusion group and the subarachnoid unclosed group. The effect of subarachnoid occlusion was studied.Summarize the surgical skills and experience, and then guide the clinical practice.ResultsThe improvement rate before operation was 37.14%?82.61% and the average improvement rate was (55.43±9.85)% in 56 patients.The mean UPDRS-? score of postoperative not taking medicine (21.45±7.14) was significantly lower than that before operation (52.43±11.03), the difference was statistically significant(P<0.05).The mean UPDRS-III score postoperative taking medicine (13.70±5.34) was significantly lower than that before operation (23.20±6.61), the difference was statistically significant (P<0.05).The average postoperative dose (234.82±102.21) mg was significantly lower than that before operation (608.66±187.55) mg, the difference was statistically significant (P<0.05),Indicating that bilateral STN-DBS on the efficacy of PD patients with certainty, and can significantly reduce the patient's drug use.56 patients with bilateral STN-DBS were successfully completed, co-implanted to stimulate the electrode 112.48 cases (85.71%) of bilateral STN were punctured once on the successful implantation of stimulation electrodes, 8 patients (14.29%)patients were implanted after stimulation of multiple electrodes;In 45 cases (80.36%),the STN signal was observed in the Intraoperative MER, and 11 (19.64%) did not record the STN signal on the side (left or right);23 cases (41.07%) observed microtransformance after implantation of tungsten microelectrode or implanted stimulating electrode; all patients were observed to be significantly improved by intraoperative stimulation;3 cases (5.36%) underwent intraoperative CT scan of the head and verify that the stimulation electrode was implanted correctly. According to the postoperative CT calculation, the displacement distance of 112 stimulation electrodes was 0?1.90mm,the average displacement distance (0.92±0.44) mm. The operative time was 2.50?7.00 h,with an average (4.41±1.04) h.56 cases of complications occurred in patients:Intracranial gas in 27 cases(48.21%);Intracranial hemorrhage in 2 cases (3.57%); circuit failure in 2 cases(3.57%); extension of the wire displacement in 3 cases (5.36%);8 cases (14.29%);dysphonia in 2 cases (3.57%); mood change in 3 cases (5.36%).The proportion of 3 times or more puncture (5.71%) was lower than that of the subarachnoid (28.57%), the difference was statistically significant (P<0.05).The incidence of intracranial gas in the subarachnoid closed group(31.43%) was lower than that in the subarachnoid unclosed group (76.19%), the difference was statistically significant (P<0.05).Indicating the use of subarachnoid closure technology can reduce the number of intraoperative puncture, reduce the incidence of intracranial gas.Conclusions1. Bilateral STN-DBS can significantly improve the MS of patient's PD, reduce the amount of anti-PD drugs;2.Intraoperative MER, intraoperative micro-damage effect observation,intraoperative stimulation effect observation, intraoperative imaging and other multiple verification methods can improve the accuracy of stimulation of electrode implantation;3. The surgeon to master the rich surgical techniques help reduce the incidence of postoperative complications;4. intraoperative use of subarachnoid closure technology can reduce the number of intraoperative puncture, reduce the incidence of postoperative intracranial gas. |
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