A comparative study of asleep and awake deep brain stimulation robot-assisted surgery for Parkinson’s disease

Abstract

To compare the differences between asleep and awake robot-assisted deep brain stimulation (DBS) surgery for Parkinson’s Disease (PD), we conducted this retrospective cohort study included 153 PD patients undergoing bilateral robot-assisted DBS from June 2017 to August 2019, of which 58 cases were performed under general anesthesia (GA) and 95 cases under local anesthesia (LA). Procedure duration, stimulation parameters, electrode implantation accuracy, intracranial air, intraoperative electrophysiological signal length, complications, and Unified PD Rating Scale (UPDRS) measurements were recorded and compared. The clinical evaluation was conducted by two raters who were blinded to the choice of anesthesia. Procedure duration was significantly shorter in the GA group, while on stimulation off medication motor scores (UPDRS-III) were significantly improved in both the GA and LA group. ANCOVA covariated for the baseline UPDRS-III and levodopa challenge exhibited no significant differences. In terms of amplitude, frequency, and pulse width, the stimulation parameters used for DBS power-on were similar. There were no significant differences in electrode implantation accuracy, intraoperative electrophysiological signal length, or intracerebral hemorrhage (no occurrences in either group). The pneumocephalus volume was significantly smaller in the GA group. Six patients exhibited transient throat discomfort associated with tracheal intubation in the GA group. The occurrence of surgical incision infection was similar in both groups. Compared with the awake group, the asleep group exhibited a shorter procedure duration with a similar electrode implantation accuracy and short-term motor improvement. Robot-assisted asleep DBS surgery is a promising surgical method for PD.

Frameless Robotic-Assisted Deep Brain Stimulation With the Mazor Renaissance System

“…21,23,24 To date, pneumocephalus has not been correlated with increased operative time, postoperative complications, or increased postoperative Unified Parkinson Disease Rating Scale measurements. [25][26][27] In our current study, pneumocephalus was only slightly correlated with older age and not associated with radial error and number of MER passes per cases, nor procedure time. Age-related cortical atrophy creating a larger space for air to enter could explain the associated increased pneumocephalus.…”

“…In addition, variable pneumocephalus volumes have been reported, as shown in select studies undergoing awake DBS (Table 4). 22,23,25,26,28,29 Mean pneumocephalus volumes spanned from 2.1 to 20.8 cm 3 in these studies, with our study's mean volume of 12.8 cm 3 within the middle of this range. In the 8 patients of our study presenting with volumes between 20 and 30 cm 3 , the number of MER passes and radial error was not increased relative to the remaining cohort.…”

The Effects of Different Anesthesia Methods on the Treatment of Parkinson’s Disease by Bilateral Deep Brain Stimulation of the Subthalamic Nucleus

“…Our study found no significant differences in the incidence of intracerebral hemorrhages or infections between the LA and GA group. However, the awake group had a larger intracranial air volume ( Blasberg et al, 2018 ; Ko et al, 2018 ; Jin et al, 2020 ). There are two possible explanations.…”

Automated optimization of deep brain stimulation parameters for modulating neuroimaging-based targets

“…Understanding the position of the electrode relative to the neuroanatomy could potentially facilitate both targeting and programming [8]. The value of imaging is highlighted by the significant increase in reports of equally efficacious outcomes with image-guided "asleep" implantation [9][10][11]. Patient-specific imaging data can also be paired with three-dimensional stimulation field models (SFMs) representing the volume of tissue activated (VTA) [12].…”