以無框立體定位深腦刺激手術治療巴金森氏病的優缺點

深腦刺激（deep brain stimulation）已被廣泛的應用在巴金森氏病（Parkinson’s disease）及肌緊張不足（dystonia）等運動障礙疾病的治療，近年來也逐漸被推廣應用在癲癇及精神病等疾病。傳統的深腦刺激手術是以有框立體定位系統（frame-based stereotactic system）來進行，近年來，由於電腦影像技術及導航系統的發展，也可以用無框立體定位系統（frameless stereotactic system）來進行。無框立體定位深腦刺激手術對於巴金森氏病病人的臨床症狀的改善及L-dopa 藥量的降低等方面與有框立體定位手術相近。以無框立體定位系統施行深腦刺激手術的步驟較複雜，它可減少手術時找到標的所須的微電極插針次數（trajectory number）及縮短微電極記錄（microelectrode recording）所須的時間，並增加手術流程的彈性；而且能減少病人在手術時受到厚重框架固定所造成的不舒服，手術中對於病人的臨床評估及與病人的溝通較容易，因此無框立體定位系統可被考慮用在不自主運動病患的深腦刺激手術。

Deep brain stimulation (DBS) has been widely used in the treatment of movement disorders such as Parkinson's disease and dystonia. In recent years, DBS has been further applied to the treatment of epilepsy and psychiatric disorder. Generally, DBS is done using the frame-based stereotactic system. However, in recent years, with the advances of computerized imaging techniques and the development of navigation system, DBS can be done by frameless stereotactic system. Both systems provide adequate accuracy for DBS targeting and show similar dosage reduction of L-dopa and clinical outcomes in patients with Parkinson's disease after DBS therapy. The procedures of the frameless system for DBS surgery are relatively complex. Using frameless stereotactic system, patients are more comfortable during the peri-operative period, especially during microelectrode recording (MER) since this system avoids the heavy frame restraint, shortens the MER time, and reduces the MER trajectory number. The frameless system offers easy access to evaluate and communicate with the patients, and has a flexible algorithm preoperatively. In conclusion, frameless stereotactic system can be considered to be a useful tool for DBS surgery in patients with movement disorders.