中文摘要：

目的探讨微电极记录和宏刺激丘脑底核在应用脑深部电刺激术（DBS）治疗帕金森病中的作用。方法回顾性分析2012年6月至2016年3月沈阳军区总医院神经外科接受DBS治疗的109例帕金森病患者的临床资料。采用头颅MRI与CT图像融合定位、单纯微电极记录或微电极记录并宏刺激确定靶点坐标，术后行MRI和（或）CT检查确定颅内电极的位置。单纯应用微电极记录69例（对照组），应用微电极记录并宏刺激40例（试验组）。调整术后DBS程控参数以达到最佳的临床疗效。疗效评估采用统一帕金森病评分量表（UPDRS）。随访时间为1.0～4.5年。结果两组电极位置和电极植入手术时间的差异均无统计学意义（均P〉0.05）,对照组的术后程控平均电压为（2.5±1.1）V，高于试验组的（2.1±0.7）V（P〈0.05）。治疗后试验组的UPDRS评分改善率为（43.7±6.9）%，高于对照组的（33.7±4.9）%（P〈0.01）。结论在DBS手术中应用微电极记录与宏刺激技术安全、有效，可结合术前影像辅助定位丘脑底核。

英文摘要：

Objective To investigate the value of intraoperative microelectrode recording （MER） and macrostimulation for targeting subthalamic nucleus （STN） in deep brain stimulation （DBS） for Parkinson＇ s disease （PD）. Methods A total of 109 PD patients undergoing STN-DBS from June 2012 to March 2016 at Neurosurgery Department of General Hospital of Shenyang Military Region were enrolled into this retrospective study. All patients underwent stereotactically guided DBS procedures based on coregistration of preoperative MRI and CT images and microelectrode recording with/without intraoperative testing for localizing STN. Positions of electrodes were identified by postoperative MRI and/or CT. MER was performed in 69 cases （control group） , and MER combined with macrostimulation were perfomled in 40 cases （experimental group）. Postoperative programming and parameter adjustment were conducted to achieve optimal clinical efficacy. The Unified Parkinson~ Disease Rating Scale （UPDRS） was applied to evaluate the treatment outcomes. The follow-up lasted for 1.0 -4. 5 year. Results The electrode location and duration of operation （ implantation ） in two groups had no significant difference （ both P 〉 0. 05 ）. Average postoperative programming voltage in control group was 2.5± 1.1 V, which was significantly higher than that in experimental group （2.1± 0.7 V, P 〈 0.05）. The increase rate of UPDRS score in experimental group was （43.7 ± 6.9） %, which was significantly higher than in control group （ 33.7 ± 4.9 ） % （ P 〈 0.01 ）. Conclusion Intraoperative MER and macrostimulation during DBS seemed to be safe and effective, .and they could facilitate localization of STN assisted by preoperative images.