Background

In most centers, the surgery of deep brain stimulation (DBS) is performed using a stereotactic frame. Compared with frame-based technique, frameless stereotaxy reduces the duration of surgical procedure and patient’s discomfort, with lead placing accuracy equivalent after the learning curve. Although several studies have investigated the targeting accuracy of this technique, only a few studies reported clinical outcomes, with data of short-term follow-up.

Objective

To assess clinical efficacy and safety of frameless bilateral subthalamic nucleus (STN) DBS in Parkinson’s disease (PD) patients at 1- and 3-year follow-up.

Methods

Consecutive PD patients who underwent bilateral STN-DBS with a manual adjustable frameless system were included in the study. The data were collected retrospectively.

Results

Eighteen PD patients underwent bilateral STN-DBS implant and were included in the study. All patients completed 1-year observation and ten of them completed 3-year observation. At 1-year follow-up, motor efficacy of STN stimulation in off-med condition was of 30.1% (P = 0.003) and at 3-year follow-up was of 36.3%, compared with off-stim condition at 3-year follow-up (P = 0.005). Dopaminergic drugs were significantly reduced by 31.2% 1 year after the intervention (P = 0.003) and 31.7% 3 years after the intervention (P = 0.04). No serious adverse events occurred during surgery.

Conclusions

Frameless stereotaxy is an effective and safe technique for DBS surgery at 1- and 3-year follow-up, with great advantages for patients’ discomfort during surgery.

中文翻译：

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丘脑深部脑刺激的无框架立体定位：3年临床结果。

背景

在大多数中心，深部脑刺激（DBS）手术是使用立体定向镜框进行的。与基于框架的技术相比，无框架立体定位减少了手术过程的持续时间和患者的不适感，学习曲线之后的导线放置精度相当。尽管有几项研究调查了该技术的靶向准确性，但只有少数研究报告了临床结果以及短期随访数据。

目的

为了评估帕金森病（PD）患者在1年和3年随访中无框架双侧丘脑下核（STN）DBS的临床疗效和安全性。

方法

该研究包括连续性PD患者，这些患者通过手动可调无框架系统接受双侧STN-DBS治疗。回顾性收集数据。

结果

18名PD患者接受了双侧STN-DBS植入，并被纳入研究。所有患者均完成1年观察，其中10位完成3年观察。与3年非刺激状态相比，在1年随访中，非医学状态下STN刺激的运动功效为30.1％（P  = 0.003），3年随访为36.3％。随访（P  = 0.005）。干预后1年多巴胺能药物显着减少31.2％（P  = 0.003），干预3年后多巴胺能药物显着减少31.7％（P  = 0.04）。手术期间未发生严重不良事件。

结论

无框架立体定位技术是一项为期1年和3年随访的DBS手术安全有效的技术，对患者手术过程中的不适感非常有利。