Deep brain stimulation of the subthalamic nucleus for parkinson's disease: awake vs asleep

Abstract

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is known to be an effective and safe neurosurgical procedure for Parkinson's disease (PD). Traditionally, awake implantation of stimulation system is carried out using microelectrode registration and intraoperative stimulation. Development of neuroimaging technologies enables direct STN imaging. Therefore, asleep surgery without additional intraoperative verification is possible. This approach reduces surgery time and can potentially decrease the incidence of hemorrhagic and infectious complications. The advantages of one method or another are being discussed. To assess the benefits and limitations of various methods for DBS system implantation for bilateral STN stimulation, to study the issues of stereotaxic accuracy, efficiency and safety of asleep and awake electrode implantation into STN. We reviewed the articles published in the PubMed database. Searching algorithm included the following keywords: «asleep DBS», «Parkinson's disease», «subthalamic nucleus», «3T MRI», «SWI», «SWAN». There were 31 articles devoted to asleep DBS of STN including 4 meta-analyses, 3 prospective controlled studies, 13 retrospective controlled studies and 11 studies without a control group. Asleep implantation of electrodes for DBS of STN can be performed only after a clear imaging of STN boundaries with high-quality MRI.