Application Of General Anesthesia And CT-MRI Image Fusion Technology In DBS Surgery For Parkinson's Disease

[Background] Parkinson's disease is a common neurodegenerative disease.Pathophysiology shows the decrease of dopamine secretion in Substantia nigra,as the main symptoms are tremor,stiffness,dyskinesia and slow action.It is a kind of disease that seriously endangers the quality of life in the middle and old age.Levodopa as a specific drug for the treatment of Parkinson's disease has been gradually deteriorated in the late stage of disease and series of side effects performed.Since the first treatment case of DBS(deep brain stimulation deep brain stimulation)for Parkinson's disease in china has been more than 20 years,the improvement of various techniques and surgical methods has been applied to pre-operation planning and operation processing in order to achieve for the most safe and effective way.The image fusion technology combines all kinds of image information,which can fully and accurately display the anatomical structure,location,function and changes of tissue or organ,and combine anatomy and function organically.Frame CT and MRI fusion image positioning have a lot of advantages in target identification,intracranial condition judgment,image quality and pre-operation plan,compared with traditional frame MRI image position calculate.It has been applied to DBS surgery and gained some initial experience.[Objective] Investigate the value of general anesthesia and CT-MRI image fusion in the DBS of Parkinson's disease.[ Methods ] Retrospectively analysis of 70 patients which were underwent STN-DBS surgery for the treatment Parkinson disease in The First Affiliated Hospital of Nanjing Medical University from June 2008 to June 2016,according to general anesthesia,local anesthesia and manual calculation by stereo-MRI image or calculating target with CTMRI fusion images,different patients were divided into 3 groups(local anesthesia + stereoMRI groups;general anesthesia + stereoMRI groups;general anesthesia +CTMRI fusion group),Statistical calculation patients' targets error,UPDRS-III score after 6 months and operation time.[ Results ] Comparatively,the first target deviation of local anesthesia group and general anesthesia group do not have significant difference,while,the second target positions has significant differences(P=0.03);There was no significant difference of the first and second target points between the GA+stereoMRI groups and the GA+ CTMRI fusion group(P > 0.05);UPDRS-III score of Parkinson patients after DBS surgery under general anesthesia(14.6±2.62and16.13±1.96)were better than the patients with local anesthesia(19.95±4.32);GA+ CT-MRI fusion groups have less time in the process of operation and targets identification.The operation time was reduced by 3.41±0.45 h,and the target time was shortened by 0.23 ±0.17 h.[ Conclusion] DBS with general anesthesia and target confirmation with fusion image is safety and reliable,and effectively reduce target error and operation time.Patients' experience is better,and postoperative motor function is improved significantly.