Abstract
Awakening during deep brain stimulation (DBS) surgery may be stressful to patients. The aim of the current study was to evaluate the effect on MER signals and their applicability to subthalmic nucleus (STN) DBS surgery for patients with Parkinson’s disease (PD) under sedation with propofol and fentanyl. Sixteen consecutive patients with PD underwent STN-DBS surgery with propofol and fentanyl. Their MER signals were achieved during the surgery. To identify the microelectrodes positions, the preoperative MRI and postoperative CT were used. Clinical profiles were also collected at the baseline and at 6 months after surgery. All the signals were slightly attenuated and contained only bursting patterns, compared with our previous report. All electrodes were mostly located in the middle one third part of the STN on both sides of the brain in the fused images. Six months later, the patients were improved significantly in the medication-off state and they met with less dyskinesia and less off-duration. Our study revealed that the sedation with propofol and fentanyl was applicable to STN-DBS surgery. There were no significant problems in precise positioning of bilateral electrodes. The surgery also improved significantly clinical outcomes in 6-month follow-up.
Highlights
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is helpful in advanced Parkinson’s disease (PD) patients with motor fluctuation and levodopa-induced dyskinesia.[1]
Most surgeons simulate targeting with brain MRI, approach the STN with Microelectrode recording (MER), and check for improvements and complications with intraoperative macrostimulation.[6, 7]
Typical STN bursting patterns appeared on both sides of the brain,[5] the background signal noise was decreased, compared to our previous report.[8] (Fig 1) Six snoring events (2 events for right side and 4 events for left side) occurred among 32 MER procedures for all patients
Summary
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is helpful in advanced Parkinson’s disease (PD) patients with motor fluctuation and levodopa-induced dyskinesia.[1] Precise localization of the electrode contacts on the STN is very important to achieve the best clinical outcome and to avoid various complications from the stimulation of surrounding structures. Intraoperative brain shift by CSF leakage and position change could cause some trouble.[3] To solve this problem, conscious patients are evaluated during the operation.[4] This could be a good method in terms of early detection of effects and complications from DBS. Most surgeons simulate targeting with brain MRI, approach the STN with MER, and check for improvements and complications with intraoperative macrostimulation.[6, 7]
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