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Tiefe Hirnstimulation mittels simultaner stereotaktischer Elektrodenplatzierung

Eine Alternative zur konventionellen funktionellen Stereotaxie?

Deep brain stimulation using simultaneous stereotactic electrode placement

An alternative to conventional functional stereotaxy?

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Zusammenfassung

Hintergrund

Die tiefe Hirnstimulation ist eine zuverlässige Methode, Bewegungsstörungen (z. B. idiopathischer Morbus Parkinson) erfolgreich behandeln zu können. Grundlage für die Operationsplanung und -umsetzung ist das stereotaktische Prinzip. Mit der sog. Starfix®-Plattform kommt erstmals ein Stereotaxierahmen zur Anwendung, der den Anforderungen einer individualisierten stereotaktischen Therapie gerecht wird.

Ziel der Arbeit

Anliegen der vorgestellten Studie ist der Vergleich zwischen konventioneller (Gruppe 1, 31 Patienten) und patientenspezifischer (Gruppe 2, 29 Patienten) Stereotaxie anhand einer retrospektiven Betrachtung.

Material und Methode

Diese Betrachtung umfasst die klinischen Parametern [UPDRS(III)] und die Medikation sowohl präoperativ als auch postoperativ nach 4 und 12 Wochen bzw. 6 und 12 Monaten.

Ergebnisse

Im Ergebnis der Studie sind beide Verfahren hinsichtlich der erreichten klinischen Verbesserung [UPDRS(III) Gruppe 1: 69,6 % vs. Gruppe 2: 72,4 %] vergleichbar und führen beide Verfahren bez. der Medikation zu einer signifikanten Reduktion der L-Dopa- und L-Dopa-Äquivalenzdosis zu allen Zeitintervallen. Darüber hinaus bestehen verfahrensimmanente Vorteile der verwendeten Stereotaxieplattform in einer simultanen Positionierung der Stimulationselektroden und einer deutlichen Operationszeitverkürzung.

Diskussion

In der Zusammenfassung sind beide stereotaktischen Verfahren zuverlässig hinsichtlich der Sicherheit bei der Platzierung von Stimulationselektroden als auch bez. des erreichten Stimulationseffektes. Die logistische Entkopplung von Operationsplanung und operativer Therapie unterstreicht die Vorteile eines individualisierten stereotaktischen Vorgehens.

Summary

Background

Deep brain stimulation (DBS) has become a reliable method in the treatment of movement disorders, e.g. idiopathic Parkinson’s disease (IPD) and is technically based on stereotaxy. The Starfix® platform is a new type of stereotactic frame that allows an individualized and patient-optimized therapeutic regimen in IPD.

Objectives

The aim of this study was to retrospectively compare the outcomes of IPD patients who underwent surgery with the use of conventional stereotactic frames (31 patients) to those who underwent implantation of DBS with the use of Starfix® frames (29 patients).

Material and methods

Surgery time, the unified Parkinson’s disease rating scale III (UPDRS/III) score, L-dopa and L-dopa equivalent doses (LED) were compared prior to surgery as well as 4 weeks, 12 weeks, 6 months and 1 year postoperatively.

Results

The IPD-related symptoms improved significantly in both groups with respect to the UPDRS III score (conventional 69.6 % vs. 72.4 % Starfix®). After surgery significant reductions of L-dopa and LED were seen in both groups. Inherent advantages of the Starfix® platform included simultaneous positioning of the stimulating electrodes and a significant reduction in surgical time.

Conclusion

In summary, both stereotactic procedures are reliable and safe procedures for the placement of stimulating electrodes as well as the stimulation effect achieved. The logistical uncoupling of presurgical planning from surgical therapy emphasizes the benefits of the individualized stereotactic procedure.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. C. Matzke, N. Hammer, D. Weise, D. Lindner, D. Fritzsch, J. Classen, J. Meixensberger und D. Winkler geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland

    C. Matzke, D. Lindner, J. Meixensberger &  D. Winkler

  2. Institut für Anatomie, Universität Leipzig, Leipzig, Deutschland

    N. Hammer

  3. Klinik und Poliklinik für Neurologie, Universität Leipzig, Leipzig, Deutschland

    D. Weise & J. Classen

  4. Abteilung für Neuroradiologie, Universität Leipzig, Leipzig, Deutschland

    D. Fritzsch

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  1. C. Matzke
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  4. D. Lindner
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  5. D. Fritzsch
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  6. J. Classen
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Correspondence to D. Winkler.

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C. Matzke und N. Hammer teilen sich die Erstautorenschaft.

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Matzke, C., Hammer, N., Weise, D. et al. Tiefe Hirnstimulation mittels simultaner stereotaktischer Elektrodenplatzierung. Nervenarzt 85, 1561–1568 (2014). https://doi.org/10.1007/s00115-014-4214-4

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