Abstract

Advancements in neuroimaging have led to a trend toward direct, image-based targeting under general anesthesia without the use of microelectrode recording (MER) or intraoperative test stimulation, also referred to as “asleep” deep brain stimulation (DBS) surgery. Asleep DBS, utilizing imaging in the form of intraoperative computed tomography (iCT) or magnetic resonance imaging (iMRI), has demonstrated reliable targeting accuracy of DBS leads implanted within the globus pallidus and subthalamic nucleus while also improving clinical outcomes in patients with Parkinson’s disease. In lieu, of randomized control trials, retrospective comparisons between asleep and awake DBS with MER have shown similar short-term efficacy with the potential for decreased complications in asleep cohorts. In lieu of long-term outcome data, awake DBS using MER must demonstrate more durable outcomes with fewer stimulation-induced side effects and lead revisions in order for its use to remain justifiable; although patient-specific factors may also be used to guide the decision regarding which technique may be most appropriate and tolerable to the patient.

Highlights

  • Deep brain stimulation (DBS) surgery is an effective treatment for movement disorders such as essential tremor (ET), dystonia and Parkinson’s disease (PD) [1,2,3]

  • /or intraoperative test stimulation; it is suggested that increased risk of intracranial hemorrhage (ICH) and cognitive decline may be related to the use of microelectrode recording (MER) [5,6,7]

  • There is no consensus on whether MER adds value or benefit to DBS surgery by improving outcomes when compared to DBS under general anesthesia without neurophysiological recording or stimulation, referred to as “asleep” DBS surgery [8,9]

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Summary

Introduction

Deep brain stimulation (DBS) surgery is an effective treatment for movement disorders such as essential tremor (ET), dystonia and Parkinson’s disease (PD) [1,2,3]. Despite these established benefits, a tremendous degree of heterogeneity exists in the way DBS surgery is performed across centers [4]. No randomized trials comparing outcomes of asleep and awake DBS surgery have been or are likely to be performed [10,11].

Advances in Neuroimaging
Targeting Accuracy
Outcomes
Findings
Future Directions
Full Text
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