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World Neurosurg. 2019 Nov 28. pii: S1878-8750(19)32957-2. doi: 10.1016/j.wneu.2019.11.117. [Epub ahead of print]

Assessment of Deep Brain Stimulation Implantation Surgery: A Practical Scale.

Author information

1
Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, 83 Wenhua Road, Shenyang 110016, China.
2
Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, 83 Wenhua Road, Shenyang 110016, China. Electronic address: yingquntao@163.com.

Abstract

BACKGROUND:

Deep brain stimulation (DBS) patients undergo extensive preoperative and postoperative evaluation, but the field lacks robust scoring system for quantifying DBS surgery.

OBJECTIVE:

To determine whether a practical scale could assess the DBS surgery and its clinical significance.

METHODS:

A retrospective study was performed of 150 patients undergoing DBS from February 2017 to February 2019. Independence analysis and multivariate testing was used to identify significant independent predictors. The scale scores were computed by summating across weighted predictors. Correlation between the scale scores and the intraoperative electrophysiological signal length (IESL), DBS power-on voltage, improvement rate in the Unified PD Rating Scale (UPDRS) and UPDRS III was analyzed and receiver operating characteristic (ROC) curve analysis quantified the discriminative capacity of the scale for predicting the prognosis.

RESULTS:

List-wise exclusion of patients with incomplete datasets yielded a final sample of 130 Parkinson's disease patients undergoing bilateral DBS. Multivariate testing identified 3 independent predictors of the prognosis including electrode implantation duration, postoperative pneumocephalus volume, and electrode fusion error. The scale scores were significantly correlated with the STN DBS power-on voltage (r=-0.4063, p<0.0001), GPi DBS power-on voltage (r=-0.4723, p=0.0014), improvement rate of UPDRS (r=0.3490, p<0.0001) and UPDRS III (r=0.6623, p<0.0001), while not significantly correlated with the STN IESL and GPi IESL. ROC curve analysis revealed impressive outcome discrimination (UPDRS, area under curve (AUC)=0.62, p=0.0219; UPDRS III, AUC=0.85, p<0.0001).

CONCLUSIONS:

We introduced a novel practical scale capable of assessing the DBS surgery and predicting the prognosis of patients following DBS.

KEYWORDS:

Assessment; Deep Brain Stimulation; Multivariate regression testing; Prognosis; Scale

PMID:
31786379
DOI:
10.1016/j.wneu.2019.11.117

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