| Objective: to study the clinical application of microelectrode recording system in deep brain stimulation of Parkinson's disease and to evaluate its value and guiding significance for postoperative program control.Methods: the clinical data of 24 patients with Parkinson's disease treated by subthalamic nucleus deep brain stimulation(STN-DBS)from February 2014 to October 2017 in the department of neurosurgery of the affiliated Hospital of Southwest Medical University were retrospectively analyzed.CT and MRI fusion localization were used before operation.The patients were divided into two groups according to whether microelectrode recording technique was used during the operation.Group A did not use microelectrode recording technique,group B applied microelectrode recording technique.There were 11 cases in group A(M 5,F 6,unilateral 4,bilateral 17).The average age of onset was(60.09 ±7.46)years and the mean course of disease was(9.27 ±1.27)years.The average daily oral dose of metadopa was(869.32 ±234.61)mg,and the mean preoperative UPDRS-? score was(57.36 ±6.00)points.There were 4 cases(36.4%)with Hoehn-Yahr stage 2.5,4 cases(36.4%)in stage 3,3 cases(27.3.1%)in stage 4.There were 13 cases in group B(M 6,F 7,unilateral 5,bilateral 8).The average age of onset was(62.92 ±5.02)years and the mean course of disease was(10.08±2.66)years.The average daily oral dose of metadopa was(942.31±158.24)mg,the mean preoperative UPDRS-? score was(56.92±5.02)points.There were 4 cases(30.8%)with Hoehn-Yahr stage 2.5,5 cases(38.5%)in stage 3,4 cases(30.8%)in stage 4.MRI imaging STN nucleus length and MER electrophysiological STN nucleus length were compared in group B.The patients in both groups were followed up for 12 months to 36 months after operation.The improvement rate of the motor scores of the unified Parkinson's disease rating scale(UPDRS-?),reduction rate of equivalent dose of levodopa and average programmed times after operation 12 months were compared between the two groups.The improvement rate of UPDRS-? score(improvement rate = [(pre-operative state score-12 months post-operation state score)/pre-operation state score]*100%,Reduction rate of equivalent dose of levodopa = [(pre-operative dose-12 months postoperative)/preoperative dose] * 100%).The data were described and inferred by SPSS20.0 software,and the level ?=0.05.When p<0.05,the difference was considered to be statistically significant.Results:There was no difference in the basic data between the two groups(P > 0.05).The data collected from the two groups were comparable.In group B,22 microelectrodes(78.5%)were successfully located at one time,and 28 MER needle tracks were used.It took an average of 1.3 pins for each DBS electrode to be implanted in group B.The length of STN nucleus recorded by microelectrode was 5.62 ±0.40 mm,which was not significantly different from that of preoperative MRI imaging STN nucleus length of 5.79±0.35mm(p> 0.05).The improvement rate of motor score in group B was(69.80 ±5.42)%,which was higher than that in group A(60.88 ±3.64)%(p< 0.05),The reduction rate of equivalent dose of levodopa in group B was(59.39 ±2.54)%,which was higher than that in group A(43.02 ±6.08)%(P < 0.05).The average number of program control in group B was significantly lower than that in group A within 12 months after operation(p<0.05).Conclusion:The application of microelectrode recording system to assist localization in deep brain stimulation surgery can effectively correct the preoperative localization deviation and improve the accuracy of the location of deep brain electrode implantation.Reduce the use of levodopa in patients and reduce the difficulty of post-operative programming. |
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