Comment

摘要

The study by Slotty and colleagues must be commended for some of the information provided. Although other studies on the topic are available, the authors correctly measured the shift of the target points instead of using surrogate measures such as the shift of the intercom-misural line. The authors demonstrate that the shift was clinically irrelevant. Brain shift due to CSF loss has early been recognized as an important source of error in deep brain stimulation surgery. Even though a negative effect on the precision of the procedure is undeniable, its real clinical importance is, in my opinion, relative. This is demonstrated by the high rate of efficacy of deep brain stimulation (DBS) for movement disorders with failures mainly ascribable to errors in patients' selection. With the current technique, it is possible to quickly insert cannulas along the selected trajectory immediately after a burr hole has been performed. Cannulas that serve to guide the microelectrode rigidly fix the brain, at least in the zone close to the target. More importantly, minimal shift due to CSF leakage are easily and reliably corrected using microelectrode recordings. This is an invaluable tool in confirming the target. This technique has contributed to the dramatic improvements that many patients have experienced with a wide array of stereotactic procedures. Nevertheless, postoperative pneumocephalus is a possible troubling complication of bilateral and long-lasting procedure such as DBS. Using burr hole sealants is a smart solution to avoid excessive CSF loss.