이상운동질환에 대한 뇌심부자극 수술 중에 미세전극 기록의분석과 유용성
Analysis and Usefulness of Microelectrode Recording during Deep Brain Stimulation Surgery in Movement Disorders
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
뇌심부자극술은 뇌심부핵에 고주파 전기자극을 전달하여 약물 불응성 이상운동질환을 치료하는 효과적인 방법이다. 그리고 미세전극기록은 뇌심부자극 수술 중에 MRI와 함께 뇌심부핵의 위치를 정확히 파악하여 수술 결과를 향상시키고 부작용을최소화 할 수 있는 보조적인 검사이다. 본 논문의 목적은 이상운동질환에 대한 뇌심부자극 수술 중에 실시한 미세전극기록을 분석하여 신경생리학적 파형과 유용성을 알아보고자 하였다. 2018년 1월부터 12월까지 이상운동질환에 대한 뇌심부자극수술 중에 미세전극기록를 실시한 환자 대상으로 후향적 조사를하였다. 총 28명의 환자 중에 시상하핵은 38 개의 MER, 내측 담창구는 10개의 MER, 복내측 시상핵은 4개의 MER을 실시했다. 모두 목표지점을 찾았고 미세자극을 이용해서 부작용의 여부를확인하고 목표지점을 재조정하였다. 수술 후 총 28명의 환자에서 모두 임상 증상은 호전되었다. 결론적으로. 미세전극기록은신경생리학적 파형을 이용해서 MRI와 함께 정확한 뇌심부핵 부위를 파악해서 이상운동질환에 대한 뇌심부자극 수술 결과를 향상시키고 부작용을 최소화할 수 있는 유용한 검사이다.
Abstract
Deep brain stimulation (DBS) is an effective surgical procedure for treating drug refractory movement disorders, and DBS involves delivering high frequency electrical stimulation to deep brain nuclei. Microelectrode recording (MER) is a complementary test that can precisely identify the location of deep brain nuclei, along with MRI correlation, during DBS surgery to improve the surgical outcome and minimize side effects. The purpose of this paper is to analyze the neuro-physiological waveforms and identify the usefulness of MER by analyzing the MER performed during DBS surgery for treating movement disorders. We retrospectively reviewed 28 patients who underwent MER during DBS surgery for movement disorders from January to December 2018. Of the 28 patients, 38 MERs for the subthalamic nucleus (STN), 10 MERs for the globuspallidusinternus (Gpi), and 4 MERs for the ventral intermediate thalamic nucleus (VIM) were performed. In all the cases, the target sites were found and micro-stimulations were used to check for side effects and to readjust the target sites. The clinical symptoms of all 28 patients improved after surgery. In conclusion, MER is a useful test that employs neuro-physiological waveforms to accurately identify the deep brain nuclei, along with MRI correlation, to improve the DBS surgical outcomes for movement disorders and to minimize side effects.
참고문헌 (20)
- Miocinovic S, "History, applications, and mechanisms of deep brain stimulation", JAMA Neurol, 70, pp.163~171 (2013)
- Benabid AL, "Long-term electrical inhibition of deep brain targets in movement disorders", Mov Disord, 13(Suppl 3), pp.119~125 (1998)
- Benabid AL, "Combined(thalamotomy and stimulation)stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease", Appl Neurophysiol, 50, pp.344~346 (1987)
- Dostrovsky JO, "Mechanisms of deep brain stimulation", Mov Disord, 17(Suppl 3), pp.63~68 (2002)
- Larson PS, "Deep brain stimulation for movement disorders", Neurotherapeutics, 11, pp.465~474 (2014)
- Acosta J, "Prevalence of Parkinson’s disease and essential tremor in a village in sourthern Spain", Neurology, 39, pp.181~ (1989)
- 고성범, "안산시에서의 파킨슨 증후군의 역학 조사", 대한신경과학회지, 21(5), pp.9~501 (2003), 대한신경과학회
- Benito-León J, "Prevalence of essential tremor in three elderly populations of central Spain", Mov Disord, 18, pp.389~394 (2003)
- Steeves TD, "The prevalence of primary dystonia : a systematic review and meta-analysis", Mov Disord, 27, pp.1789~1796 (2012)
- Johnson MD, "Mechanisms and targets of deep brain stimulation in movement disorders", Neurotherapeutics, 5, pp.294~308 (2008)
- Burchiel K, "MRI distortion and stereotactic neurosurgery using the Cosman-Roberts-Wells and Leksell frames", Stereotac Funct Neurosurg, 66, pp.123~136 (1996)
- Holtzheimer PE III, "Magnetic resonance imaging versus computed tomography for target localization in functional stereotactic neurosurgery", Neurosurgery, 45, pp.290~298 (1999)
- Lozano A, "Methods for microelectrode-guided posteroventral pallidotomy", J Neurosurg, 84, pp.194~202 (1996)
- Vitek JL, "Microelectrode-guided pallidotomy : technical approach and its application in medically intractable Parkinson’s disease", J Neurosurg, 88, pp.1027~1043 (1998)
- Hutchison WD, "Neurophysiological identification of the subthalamic nucleus in surgery for Parkinson’s disease", Ann Neurol, 44, pp.622~628 (1998)
- Sterio D, "Neurophysiological properties of pallidal neurons in Parkinson’s disease", Ann Neurol, 35, pp.586~591 (1994)
- Molnar GF, "Differences in neuronal firing rates in pallidal and cerebellar receiving areas of thalamus in patients with Parkinson’s disease, essential tremor, and pain", J Neurophysiol, 93, pp.3094~3101 (2005)
- Gross RE, "Electrophysiological mapping for the implantation of deep brain stimulators for Parkinson’s disease and tremor", Mov Disord, 21(Suppl 14), pp.259~283 (2006)
- Starr PA, "Microelectrode-guided implantation of deep brain stimulators into the globus pallidus internus for dystonia : techniques, electrode locations, and outcomes", J Neurosurg, 104, pp.488~501 (2006)
- Molinuevo JL, "Usefulness of neurophysiologic techniques in stereotactic subthalamic nucleus stimulation for advanced Parkinson’s disease", Clin Neurophysiol, 114, pp.1793~1799 (2003)