Abstract
Bilateral subthalamic nucleus (STN) Deep brain stimulation (DBS) is a well-established treatment in patients with Parkinson’s disease (PD). Traditionally, STN DBS for PD is performed by using microelectrode recording (MER) and/or intraoperative macrostimulation under local anesthesia (LA). However, many patients cannot tolerate the long operation time under LA without medication. In addition, it cannot be even be performed on PD patients with poor physical and neurological condition. Recently, it has been reported that STN DBS under general anesthesia (GA) can be successfully performed due to the feasible MER under GA, as well as the technical advancement in direct targeting and intraoperative imaging. The authors reviewed the previously published literature on STN DBS under GA using intraoperative imaging and MER, focused on discussing the technique, clinical outcome, and the complication, as well as introducing our single-center experience. Based on the reports of previously published studies and ours, GA did not interfere with the MER signal from STN. STN DBS under GA without intraoperative stimulation shows similar or better clinical outcome without any additional complication compared to STN DBS under LA. Long-term follow-up with a large number of the patients would be necessary to validate the safety and efficacy of STN DBS under GA.
Highlights
Parkinson’s disease (PD) is the second most common neurodegenerative disease following Alzheimer’s disease, characterized by bradykinesia, rigidity, resting tremor and postural instability [1].The long-term use of anti-Parkinsonian drugs has been found to be associated with dyskinesia and symptom fluctuation
A few small-sized retrospective studies have reported that microelectrode recording (MER) obtained from subthalamic nucleus (STN), globus pallidus (GPi), substantia nigra in STN Deep brain stimulation (DBS) surgery under general anesthesia (GA) with both volatile and intravenous anesthetics in PD and dystonia patients showed no significant difference compared with patients awake during the procedure [54,88,89,90,91]
STN DBS surgery is performed in various ways with or without MER under local anesthesia (LA) or GA in each center
Summary
Parkinson’s disease (PD) is the second most common neurodegenerative disease following Alzheimer’s disease, characterized by bradykinesia, rigidity, resting tremor and postural instability [1]. DBS surgery is performed under local anesthesia (LA) and conscious sedation to evaluate clinical benefit and side effects by localizing electrophysiological target using microelectrode recording (MER) and/or intraoperative test stimulation while the patient is awake [6,7,8,9,10,11,12,13,14,15]. Patient cooperation is one of the factors that may influence the outcome after surgery Because of these concerns, many authors have consistently tried STN DBS under GA and reported that the clinical outcome is not inferior compared to under LA. The technique and clinical outcome using intraoperative imaging and MER in DBS under GA are thoroughly reviewed along with the introduction of single-center experience of our institution
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