Reliability of Intraoperative Testing During Deep Brain Stimulation Surgery

Sammartino, Francesco; Rege, Rahul; Krishna, Vibhor

doi:10.1111/ner.13081

Cited by 10 publications

(10 citation statements)

References 10 publications

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“…In the last 30 years, awake surgery has been widely performed 7 , most often under LA with intraoperative test stimulation 3 . During awake surgery and without intraoperative imaging, neurosurgeons determine electrode placement by relying on electrophysiological typical signals and the patients' symptom relief without any side effects.…”

Section: Discussionmentioning

confidence: 99%

“…Deep brain stimulation (DBS) surgery is an effective treatment for Parkinson’s disease (PD) 1 , 2 . To date, awake surgery has been typically performed with intraoperative test stimulations 3 . Recently, asleep surgery has been performed under general anesthesia (GA) with intraoperative magnetic resonance imaging (iMRI) 4 or computed tomography (iCT) 5 to confirm the position of the electrode tip.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…We do not present outcome data which are topic of separate investigations. It is, however, generally accepted that intraoperative stimulation effects are correlated to clinical outcome [58] and that these effects can be reflective of the mere distance to target white matter tracts [12,58]. Long-term results would have been of particular interest.…”

Section: Limitationsmentioning

confidence: 99%

The dentato-rubro-thalamic tract as the potential common deep brain stimulation target for tremor of various origin: an observational case series

et al. 2020

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Introduction Deep brain stimulation alleviates tremor of various origins. The dentato-rubro-thalamic tract (DRT) has been suspected as a common tremor-reducing structure. Statistical evidence has not been obtained. We here report the results of an uncontrolled case series of patients with refractory tremor who underwent deep brain stimulation under tractographic assistance. Methods A total of 36 patients were enrolled (essential tremor (17), Parkinson's tremor (8), multiple sclerosis (7), dystonic head tremor (3), tardive dystonia (1)) and received 62 DBS electrodes (26 bilateral; 10 unilateral). Preoperatively, diffusion tensor magnetic resonance imaging sequences were acquired together with high-resolution anatomical T1W and T2W sequences. The DRT was individually tracked and used as a direct thalamic or subthalamic target. Intraoperative tremor reduction was graded on a 4-point scale (0 = no tremor reduction to 3 = full tremor control) and recorded together with the current amplitude, respectively. Stimulation point coordinates were recorded and compared to DRT. The relation of the current amplitude needed to reduce tremor was expressed as TiCR (tremor improvement per current ratio). Results Stimulation points of 241 were available for analysis. A total of 68 trajectories were tested (62 dB leads, 1.1 trajectories tested per implanted lead). Tremor improvement was significantly decreasing (p < 0.01) if the distance to both the border and the center of the DRT was increasing. On the initial trajectory, 56 leads (90.3%) were finally placed. Long-term outcomes were not part of this analysis. Discussion Tremor of various origins was acutely alleviated at different points along the DRT fiber tract (above and below the MCP plane) despite different tremor diseases. DRT is potentially a common tremor-reducing structure. Individual targeting helps to reduce brain penetrating tracts. TiCR characterizes stimulation efficacy and might help to identify an optimal stimulation point.Keywords Deep brain stimulation . DRT . DRTT . Brain . Diffusion tensor magnetic resonance imaging . MRI . Parkinson's disease . Tremor Bastian Sajonz contributed equally to this work.

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“…However, asleep VIM DBS remains challenging because this nucleus is not readily visible on conventional structural imaging. Furthermore, physiological feedback during asleep VIM DBS is currently lacking, and it may ultimately be required as a surrogate for long-term clinical outcomes similar to intraoperative testing during awake DBS ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Functional Neuroimaging During Asleep DBS Surgery: A Proof of Concept Study

et al. 2021

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Object: A real-time functional magnetic resonance imaging (fMRI) feedback during ventral intermediate nucleus (VIM) deep brain stimulation (DBS) under general anesthesia (or “asleep” DBS) does not exist. We hypothesized that it was feasible to acquire a reliable and responsive fMRI during asleep VIM DBS surgery.Methods: We prospectively enrolled 10 consecutive patients who underwent asleep DBS for the treatment of medication-refractory essential tremor. Under general anesthesia, we acquired resting-state functional MRI immediately before and after the cannula insertion. Reliability was determined by a temporal signal-to-noise-ratio >100. Responsiveness was determined based on the fMRI signal change upon insertion of the cannula to the VIM.Results: It was feasible to acquire reliable fMRI during asleep DBS surgery. The fMRI signal was responsive to the brain cannula insertion, revealing a reduction in the tremor network's functional connectivity, which did not reach statistical significance in the group analysis.Conclusions: It is feasible to acquire a reliable and responsive fMRI signal during asleep DBS. The acquisition steps and the preprocessing pipeline developed in these experiments will be useful for future investigations to develop fMRI-based feedback for asleep DBS surgery.

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Reliability of Intraoperative Testing During Deep Brain Stimulation Surgery

Cited by 10 publications

References 10 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

The dentato-rubro-thalamic tract as the potential common deep brain stimulation target for tremor of various origin: an observational case series

Functional Neuroimaging During Asleep DBS Surgery: A Proof of Concept Study

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