Abstract
Spinal cord stimulation (SCS) has been shown to influence cerebral perfusion in both experimental models and humans. With the aim of further verifying such an effect, twelve patients had an epidural (cervical or dorsal) lead inserted percutaneously and underwent regional cerebral blood flow (rCBF) examinations (133-Xenon inhalation method) before and during SCS. Mean blood velocity (MBV) in the middle cerebral artery was also measured in seven cases by means of transcranial Doppler. In the patients with a cervical lead, a symmetrical increase in rCBF was found, mainly in the anterior regions (from +8% to +21%). MBV increased in four cervical lead implants (from +16% to +20%) and in one case with a dorsal lead (+15%). These results suggest that cerebral perfusion may increase in patients undergoing SCS through a cervical lead. Although the mechanism involved in the increase in rCBF remains to be clarified, frontal lobe functional activation by the ascending reticular pathways through the thalamo-cortical projections might be hypothesised.
Sommario
La Stimolazione Midollare Cervicale epidurale (SCS) può influenzare la perfusione cerebrale come già dimostrato in modelli sperimentali ed in clinica. Lo scopo del nostro studio è stato di verificare tale effetto in dodici pazienti sottoposti ad impianto percutaneo di elettrodo (cervicale o dorsale) per patologie diverse. In tutti i pazienti è stato effettuato uno studio del Flusso Ematico Cerebrale (FEC) con metodo inalatorio allo Xe-133, ed una determinazione della Velocità Media (VM) di flusso dell'arteria cerebrale media con Transcranial Doppler in 7 casi. Nei pazienti con elettrodo cervicale è stato osservato un aumento simmetrico del FEC compreso tra l'8% ed il 21%, prevalente nelle regioni anteriori. La VM mostrò un incremento nei 4 impianti cervicali ed in un caso con impianto dorsale con valori compresi tra il 15% ed il 20%. Nei rimanenti pazienti con impianto dorsale nessuna modificazione del FEC e della VM fu registrata. Questi risultati sembrano indicare che la perfusione cerebrale può essere modificata durante la stimolazione cervicale anche se il meccanismo fisiopatologico responsabile di tali modificazioni resta ancora da chiarire; potrebbe essere ipotizzata un'attivazione funzionale dei lobi frontali da parte del sistema reticolare ascendente attraverso le proiezioni talamo-corticali.
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Mazzone, P., Rodriguez, G., Arrigo, A. et al. Cerebral haemodynamic changes induced by spinal cord stimulation in man. Ital J Neuro Sci 17, 55–57 (1996). https://doi.org/10.1007/BF01995709
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DOI: https://doi.org/10.1007/BF01995709