| Objective:To explore the technique of minimally invasive surgery for deep brain stimulation using stereotactic framework under the guidance of multimodal image and electrophysiology in the pursuit of safety and accuracy,and on the premise of minimizing bleeding,infection,epilepsy and other surgical complicationsMethods:From January 2016 to December 2018,174 patients with advanced Parkinson's disease in the Brain Hospital Affiliated to Nanjing Medical University were retrospectively analyzed.Two of them were unilateral DBS,the others were bilateral,totaling 346 sides.The improved procedure was adopted during the operationt under the single-cell electrical electrophysiological monitoring of Microelectrode Recording(MER),and the details of the operation were paid attention to.After the operation,the image review was compared with the operation plan,and the error between the actual electrode position and the plan was analyzed.Preoperative and postoperative MR and CT multimodal image fusion were used for surgical planning and postoperative implantation accuracy confirmationResults:In this group of 346 implantations,the optimal contact position and planned position differed by an average of 0.74±0.19mm.All the optimal contact centers were in the STN nuclei.The optimum contact deviation maximum distance is 1.13mm,which is smaller than the electrode diameter(1.3mm).In this group,a small amount of asymptomatic hemorrhage on the side of the cortex,accounting for 0.29%of the 346 side of the group.In most patients,unilateral intracranial gas accumulation was 10ml,?30ml intracranial gas accumulation in 3 cases,and the optimal contact of the electrode was not significantly offsetConclusion:DBS requires highly refined surgery,in particular minimally invasive as the dura and the cortex processing.In every aspect and detail given suff-icient attention and refinement of the operation,as far as possible in order to improve the accuracy of electrode implantation,reduce postoperative complications.MER and multi-modal image fusion can effectively improve electrode implantation accuracyObjective:To assess whether functional neural connectivity is disrupted between the regions of the default mode network(DMN)and Executive control network(ECN)after deep brain stimulation(DB S)of the subthalamic nucleus(STN)in Parkinson's disease(PD)patients.Methods:50 elderly individuals,including 36 PD patients and 14 age-and gender-matched healthy controls(CN)a were evaluated,using resting-state functional magnetic resonance imaging(MRI),T1-weighted MRI.13 PD patients were excluded due to excessive motion artifacts.Functional connectivity between the regions of the DMN and ECN was assessed with seed-to-voxel connectivityResults:significantly difference was observed on DMN and ECN connectivity patterns among CN,pre-operation Parkinson's disease patients(prePD),and post-operation Parkinson's disease patients(postPD).Compared with prePD,postPD showed significantly increased functional connectivity between PCC and left postcentral gyrus in DMN;and DLPFC and the right middle occipital gyrus in ECN.Conclusions:These results demonstrate that DBS can enhance functional connectivity o PCC and left postcentral gyrus.This could explain the role of STN-DBS in the treatment of Parkinson's disease to a certain extent.The connection between DLPFC and the right middle occipital gyrus in the executive control network returned to normal levels,which can explain the role of DBS in PD treatment to a certain extent,and can improve emotional symptoms such as motor symptoms and depression in postoperative patients. |
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