Asleep Deep Brain Stimulation Reduces Incidence of Intracranial Air during Electrode Implantation

Magown, Philippe; Ozpinar, Alp; Hamzaoğlu, Vural; Burchiel, Kim J.

doi:10.1159/000488150

Cited by 33 publications

(20 citation statements)

References 31 publications

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“…Recent studies 15,17,23,24 have demonstrated that the incidence of intracerebral hemorrhages, infections, and epilepsy were similar between asleep and awake DBS surgery, which is generally consistent with our results. In this study, the volume of intracranial air was significantly lower in the GA group than that in the LA group, which is consistent with previous reports 17,25 . Awake DBS resulted in significantly larger cortical brain shifts 25 .…”

Section: Discussionsupporting

confidence: 93%

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

Jin

Gong

Tao

et al. 2020

npj Parkinsons Dis.

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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.

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Section: Discussionsupporting

confidence: 93%

“…In this study, the volume of intracranial air was significantly lower in the GA group than that in the LA group, which is consistent with previous reports 17,25 . Awake DBS resulted in significantly larger cortical brain shifts 25 . Additionally, awake DBS surgery has the disadvantage of potential local anesthetic drug allergies 26 .…”

Section: Discussionsupporting

confidence: 93%

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

Jin

Gong

Tao

et al. 2020

npj Parkinsons Dis.

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“…Successful clinical results on the intraoperative imaging to verify the accuracy of STN lead position instead of electrophysiological structure mapping or stimulation tests during DBS surgery have been reported [23,29,31,37,[40][41][42][43][44]. In recent studies on the advancement of intraoperative imaging, no significant clinical results were found when compared to awake DBS [16,30,37,45,46].…”

Section: Using Intraoperative Imagingmentioning

confidence: 99%

Bilateral Subthalamic Nucleus Deep Brain Stimulation under General Anesthesia: Literature Review and Single Center Experience

Park

Lim

Song

et al. 2020

JCM

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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.

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“…Factors such as intraoperative CSF leakage, degree of pneumocephalus, body position, burr hole sealing, and number of punctures have been investigated as causes of lead position accuracy. 14) However, the resolution of the O-arm makes it difficult to confirm brain parenchyma misalignment intraoperatively. Reduction of pneumocephalus during sedated DBS can improve the accuracy of electrode position, and the use of intraoperative imaging remains a potential way to identify and improve the accuracy of intraoperative pneumocephalus.…”

Section: Accuracymentioning

confidence: 99%

Fusing of Preoperative Magnetic Resonance and Intraoperative O-arm Images in Deep Brain Stimulation Enhance Intuitive Surgical Planning and Increase Accuracy of Lead Placement

Aoki

Matsumae

2021

Neurol. Med. Chir.(Tokyo)

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Intraoperative fluoroscopy and microelectrode recording (MER) are useful techniques for guiding lead placement in deep brain stimulation (DBS). Recent advances in magnetic resonance imaging (MRI) have enabled information on the location of the basal ganglia, as the target of DBS, to be obtained preoperatively. However, intraoperative images with few artifacts are required to enable accurate fusion of preoperative imaging data with intraoperative lead position data. With our method, we first fuse preoperative MRI and pre-frame fixed computed tomography (CT) images, then fuse the CT images exactly after mounting the frame, using this fusion image as a platform image. Compared with before and after frame fixation, the pre-frame fixed CT has less artifacts, facilitating the identification of soft tissues such as the ventricles and cortical surface on pre-frame fixed CT images. By fusing the structural information for these soft tissues between pre-frame fixed CT and MR images, this fusion process can provide improved accuracy that is intuitively understood by the surgeon. Using platform images, surgical planning and intraoperative lead positioning can then be evaluated on the same coordinate axis. Positional data on the lead acquired as three-dimensional (3D) data are then added to the platform image. The proposed surgical steps permit the acquisition of accurate lead position data.

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Asleep Deep Brain Stimulation Reduces Incidence of Intracranial Air during Electrode Implantation

Cited by 33 publications

References 31 publications

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

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

Bilateral Subthalamic Nucleus Deep Brain Stimulation under General Anesthesia: Literature Review and Single Center Experience

Fusing of Preoperative Magnetic Resonance and Intraoperative O-arm Images in Deep Brain Stimulation Enhance Intuitive Surgical Planning and Increase Accuracy of Lead Placement

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