Introduction

Optimal placement of Deep Brain Stimulation (DBS) lead is critical to ensure an adequate therapeutic benefit and minimize stimulation-induced side effects.

Methods

We reviewed data from 2004 to 2018 of all cases of essential tremor treated with thalamic DBS at the University of Cincinnati. All procedures were performed with the patient awake. Change in parallel trajectory was classified as major repositioning, whereas a change in depth of electrode classified as minor repositioning. The following data were compared between groups (no vs. minor vs. major repositioning): age at surgery, sex, AC-PC length, third ventricle width, cerebral atrophy, small vessel disease burden, and intraoperative tremor control. Univariate and multivariate analyses were conducted to identify factors associated with intraoperative repositioning.

Results

Of the 127 encounters with essential tremor, 71 required repositioning (33 major and 38 minor). Comparing procedures with major, minor, and no repositioning, mean number of changes per procedure (4 vs. 1.2 vs 0; p < 0.001) and AC-PC length (26 vs. 27 vs. 27.2 mm; p = 0.021) differed between the three groups. Older age at surgery (OR 1.04, p = 0.042), left side (OR 2.56, p = 0.04) and decrease in AC-PC length (OR 1.33, p = 0.026) were associated with greater odds of any (minor or major) repositioning. A decrease in AC-PC length was associated with greater odds of major repositioning (OR 1.37, p = 0.009).

Conclusion

Intraoperative functional testing may be critical to ensure the accuracy of thalamic DBS targeting based on neuroimaging data, particularly in patients with reduced AC-PC length.

中文翻译：

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丘脑深部脑震荡刺激：术中测试的关键作用。

介绍

深度脑刺激（DBS）导联的最佳放置对于确保足够的治疗效果并最小化刺激引起的副作用至关重要。

方法

我们回顾了辛辛那提大学2004年至2018年使用丘脑DBS治疗的所有原发性震颤病例的数据。所有程序均在患者清醒的情况下执行。平行轨迹的变化被分类为主要重新定位，而电极深度的变化则被分类为次要重新定位。比较了以下数据在各组之间的比较（无，轻度与重度重定位）：手术年龄，性别，AC-PC长度，第三脑室宽度，脑萎缩，小血管疾病负担和术中震颤控制。进行单因素和多因素分析，以确定与术中重新定位相关的因素。

结果

在127次与原发性震颤相遇的事件中，有71次需要重新定位（33次重度和38次轻度）。比较具有重大，次要和无重定位的程序，每个程序的平均更改次数（4 vs. 1.2 vs 0； p <0.001）和AC-PC长度（26 vs. 27 vs. 27.2 mm； p = 0.021）之间存在差异这三组。手术年龄较大（OR 1.04，p = 0.042），左侧（OR 2.56，p = 0.04）和AC-PC长度减少（OR 1.33，p = 0.026）与更大的赔率相关（次要或主要）重新定位。AC-PC长度的减少与较大的重定位几率相关（OR 1.37，p = 0.009）。

结论

术中功能测试对于确保基于神经影像数据的丘脑DBS定位的准确性可能至关重要，特别是在AC-PC长度缩短的患者中。