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Huang Z, Meng L, Bi X, Xie Z, Liang W, Huang J. Efficacy and safety of robot-assisted deep brain stimulation for Parkinson's disease: a meta-analysis. Front Aging Neurosci 2024; 16:1419152. [PMID: 38882524 PMCID: PMC11176545 DOI: 10.3389/fnagi.2024.1419152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 05/20/2024] [Indexed: 06/18/2024] Open
Abstract
Objective This meta-analysis aims to assess the effectiveness and safety of robot-assisted deep brain stimulation (DBS) surgery for Parkinson's disease(PD). Methods Four databases (Medline, Embase, Web of Science and CENTRAL) were searched from establishment of database to 23 March 2024, for articles studying robot-assisted DBS in patients diagnosed with PD. Meta-analyses of vector error, complication rate, levodopa-equivalent daily dose (LEDD), Unified Parkinson's Disease Rating Scale (UPDRS), UPDRS II, UPDRS III, and UPDRS IV were performed. Results A total of 15 studies were included in this meta-analysis, comprising 732 patients with PD who received robot-assisted DBS. The pooled results revealed that the vector error was measured at 1.09 mm (95% CI: 0.87 to 1.30) in patients with Parkinson's disease who received robot-assisted DBS. The complication rate was 0.12 (95% CI, 0.03 to 0.24). The reduction in LEDD was 422.31 mg (95% CI: 68.69 to 775.94). The improvement in UPDRS, UPDRS III, and UPDRS IV was 27.36 (95% CI: 8.57 to 46.15), 14.09 (95% CI: 4.67 to 23.52), and 3.54 (95% CI: -2.35 to 9.43), respectively. Conclusion Robot-assisted DBS is a reliable and safe approach for treating PD. Robot-assisted DBS provides enhanced accuracy in contrast to conventional frame-based stereotactic techniques. Nevertheless, further investigation is necessary to validate the advantages of robot-assisted DBS in terms of enhancing motor function and decreasing the need for antiparkinsonian medications, in comparison to traditional frame-based stereotactic techniques.Clinical trial registration: PROSPERO(CRD42024529976).
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Affiliation(s)
- Zhilong Huang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Lian Meng
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Xiongjie Bi
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Zhengde Xie
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Weiming Liang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Jinyu Huang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
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Fayed I, Smit RD, Vinjamuri S, Kang K, Sathe A, Sharan A, Wu C. Robot-Assisted Minimally Invasive Asleep Single-Stage Deep Brain Stimulation Surgery: Operative Technique and Systematic Review. Oper Neurosurg (Hagerstown) 2024; 26:363-371. [PMID: 37888994 DOI: 10.1227/ons.0000000000000977] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/16/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Robotic assistance has garnered increased use in neurosurgery. Recently, this has expanded to include deep brain stimulation (DBS). Several studies have reported increased accuracy and improved efficiency with robotic assistance, but these are limited to individual robotic platforms with smaller sample sizes or are broader studies on robotics not specific to DBS. Our objectives are to report our technique for robot-assisted, minimally invasive, asleep, single-stage DBS surgery and to perform a meta-analysis comparing techniques from previous studies. METHODS We performed a single-center retrospective review of DBS procedures using a floor-mounted robot with a frameless transient fiducial array registration. We compiled accuracy data (radial entry error, radial target error, and 3-dimensional target error) and efficiency data (operative time, setup time, and total procedure time). We then performed a meta-analysis of previous studies and compared these metrics. RESULTS We analyzed 315 electrodes implanted in 160 patients. The mean radial target error was 0.9 ± 0.5 mm, mean target 3-dimensional error was 1.3 ± 0.7 mm, and mean radial entry error was 1.1 ± 0.8 mm. The mean procedure time (including pulse generator placement) was 182.4 ± 47.8 minutes, and the mean setup time was 132.9 ± 32.0 minutes. The overall complication rate was 8.8% (2.5% hemorrhagic/ischemic, 2.5% infectious, and 0.6% revision). Our meta-analysis showed increased accuracy with floor-mounted over skull-mounted robotic platforms and with fiducial-based registrations over optical registrations. CONCLUSION Our technique for robot-assisted, minimally invasive, asleep, single-stage DBS surgery is safe, accurate, and efficient. Our data, combined with a meta-analysis of previous studies, demonstrate that robotic assistance can provide similar or increased accuracy and improved efficiency compared with traditional frame-based techniques. Our analysis also suggests that floor-mounted robots and fiducial-based registration methods may be more accurate.
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Affiliation(s)
- Islam Fayed
- Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Rupert D Smit
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Shreya Vinjamuri
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - KiChang Kang
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Anish Sathe
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Ashwini Sharan
- Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Chengyuan Wu
- Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
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Catalano Chiuvé S, Momjian S, Wolff A, Corniola MV. Effectiveness and reliability of hypnosis in stereotaxy: a randomized study. Acta Neurochir (Wien) 2024; 166:112. [PMID: 38411747 PMCID: PMC10899299 DOI: 10.1007/s00701-024-05943-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/04/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Patients suffering from Parkinson's disease (PD) may experience pain during stereotactic frame (SF) fixation in deep brain stimulation (DBS). We assessed the role of hypnosis during the SF fixation in PD patients undergoing awake bilateral subthalamic nucleus (STN) DBS. METHODS N = 19 patients were included (N = 13 males, mean age 63 years; N = 10 allocated to the hypnosis and N = 9 allocated to the control groups). Patients were randomly assigned to the interventional (hypnosis and local anesthesia) or non-interventional (local anesthesia only) groups. The primary outcome was the pain perceived (the visual analogue scale (VAS)). Secondary outcomes were stress, anxiety, and depression, as measured by the perceived stress scale (PSS) and hospital anxiety and depression scale (HADS). Procedural distress was measured using the peritraumatic distress inventory (PDI-13). RESULTS In the hypnosis group, VASmean was 5.6 ± 2.1, versus 6.4 ± 1.2 in the control group (p = 0.31). Intervention and control groups reported similar VASmax scores (7.6 ± 2.1 versus 8.6 ± 1.6 (p = 0.28), respectively). Both groups had similar HADS scores (6.2 ± 4.3 versus 6.7 ± 1.92, p = 0.72 (HADSa) and 6.7 ± 4.2 versus 7.7 ± 3, p = 0.58 (HADSd)), so were the PSS scores (26.1 ± 6.3 versus 25.1 ± 7, p = 0.75). Evolutions of VASmean (R2 = 0.93, 95% CI [0.2245, 1.825], p = 0.03) and PDI-13 scores (R2 = 0.94, 95% CI [1.006, 6.279], p = 0.02) significantly differ over follow-up with patients in the hypnosis groups showing lower scores. CONCLUSION In this unblinded, randomized study, hypnosis does not influence pain, anxiety, and distress during awake SF fixation but modulates pain memory over time and may prevent the integration of awake painful procedures as a bad experience into the autobiographical memory of patients suffering from PD. A randomized controlled study with more data is necessary to confirm our findings.
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Affiliation(s)
- Sabina Catalano Chiuvé
- Neurology Department, Neuropsychology Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Shahan Momjian
- Faculty of Medicine, Université of Genève, Geneva, Suisse
- Neurosurgery Department, Geneva University Hospitals, Geneva, Switzerland
| | - Adriana Wolff
- Anesthesiology Department, Geneva University Hospitals, Geneva, Switzerland
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Liu Z, Zhou Y, Gao Y, Hu X. Editorial: Insights into the use of deep brain stimulation as a treatment for Parkinson's disease and related conditions. Front Neurosci 2023; 17:1322091. [PMID: 38033545 PMCID: PMC10684966 DOI: 10.3389/fnins.2023.1322091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/01/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Zhi Liu
- Neurosurgery Department, The First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Yi Zhou
- Department of Neurology, 980 Hospital of PLA Joint Logistics Support Forces, Shijiazhuang, Hebei, China
| | - Ya Gao
- Neuroscience Institute, Dietrich College of Humanities and Social Sciences, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Xiaofei Hu
- Department of Nuclear Medicine, Southwest Hospital, Army Medical University, Chongqing, China
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Frameless Robot-Assisted Asleep Centromedian Thalamic Nucleus Deep Brain Stimulation Surgery in Patients with Drug-Resistant Epilepsy: Technical Description and Short-Term Clinical Results. Neurol Ther 2023; 12:977-993. [PMID: 36892782 DOI: 10.1007/s40120-023-00451-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/02/2023] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION This purpose of this work is to give a detailed description of a surgical technique for frameless robot-assisted asleep deep brain stimulation (DBS) of the centromedian thalamic nucleus (CMT) in drug-resistant epilepsy (DRE). METHODS Ten consecutively enrolled patients who underwent CMT-DBS were included in the study. The FreeSurfer "Thalamic Kernel Segmentation" module and experience target coordinates were used for locating the CMT, and quantitative susceptibility mapping (QSM) images were used to check the target. The patient's head was secured with a head clip, and electrode implantation was performed with the assistance of the neurosurgical robot Sinovation®. After opening the dura, the burr hole was continuously flushed with physiological saline to stop air from entering the skull. All procedures were performed under general anesthesia without intraoperative microelectrode recording (MER). RESULTS The mean age of the patients at surgery and onset of seizures was 22 years (range 11-41 years) and 11 years (range 1-21 years), respectively. The median duration of seizures before CMT-DBS surgery was 10 years (2-26 years). CMT was successfully segmented, and its position was verified by experience target coordinates and QSM images in all ten patients. The mean surgical time for bilateral CMT-DBS in this cohort was 165 ± 18 min. The mean pneumocephalus volume was 2 cm3. The median absolute errors in the x-, y-, and z-axes were 0.7 mm, 0.5 mm, and 0.9 mm, respectively. The median Euclidean distance (ED) and radial error (RE) was 1.3 ± 0.5 mm and 1.0 ± 0.3 mm, respectively. No significant difference was found between right- and left-sided electrodes regarding the RE nor the ED. After a mean 12-month follow-up, the average reduction in seizures was 61%, and six patients experienced a ≥ 50% reduction in seizures, including one patient who had no seizures after the operation. All patients tolerated the anesthesia operation, and no permanent or serious complications were reported. CONCLUSIONS Frameless robot-assisted asleep surgery is a precise and safe approach for placing CMT electrodes in patients with DRE, shortening the surgery time. The segmentation of the thalamic nuclei enables the precise location of the CMT, and the flow of physiological saline to seal the burr holes is a good way to reduce the influx of air. CMT-DBS is an effective method to reduce seizures.
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Nomogram for Prediction of Postoperative Delirium after Deep Brain Stimulation of Subthalamic Nucleus in Parkinson’s Disease under General Anesthesia. PARKINSON'S DISEASE 2022; 2022:6915627. [DOI: 10.1155/2022/6915627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/04/2022] [Accepted: 09/07/2022] [Indexed: 12/05/2022]
Abstract
Introduction. Postoperative delirium can increase cognitive impairment and mortality in patients with Parkinson’s disease. The purpose of this study was to develop and internally validate a clinical prediction model of delirium after deep brain stimulation of the subthalamic nucleus in Parkinson’s disease under general anesthesia. Methods. We conducted a retrospective observational cohort study on the data of 240 patients with Parkinson’s disease who underwent deep brain stimulation of the subthalamic nucleus under general anesthesia. Demographic characteristics, clinical evaluation, imaging data, laboratory data, and surgical anesthesia information were collected. Multivariate logistic regression was used to develop the prediction model for postoperative delirium. Results. A total of 159 patients were included in the cohort, of which 38 (23.90%) had postoperative delirium. Smoking (OR 4.51, 95% CI 1.56–13.02,
) was the most important risk factor; other independent predictors were orthostatic hypotension (OR 3.42, 95% CI 0.90–13.06,
), inhibitors of type-B monoamine oxidase (OR 3.07, 95% CI 1.17–8.04,
), preoperative MRI with silent brain ischemia or infarction (OR 2.36, 95% CI 0.90–6.14,
), Hamilton anxiety scale score (OR 2.12, 95% CI 1.28–3.50,
), and apolipoprotein E level in plasma (OR 1.48, 95% CI 0.95–2.29,
). The area under the receiver operating characteristic curve (AUC) was 0.76 (95% CI 0.66–0.86). A nomogram was established and showed good calibration and clinical predictive capacity. After bootstrap for internal verification, the AUC was 0.74 (95% CI 0.66–0.83). Conclusion. This study provides evidence for the independent inducing factors of delirium after deep brain stimulation of the subthalamic nucleus in Parkinson’s disease under general anesthesia. By predicting the development of delirium, our model may identify high-risk groups that can benefit from early or preventive intervention.
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Malekmohammadi M, Mustakos R, Sheth S, Pouratian N, McIntyre CC, Bijanki KR, Tsolaki E, Chiu K, Robinson ME, Adkinson JA, Oswalt D, Carcieri S. Automated optimization of deep brain stimulation parameters for modulating neuroimaging-based targets. J Neural Eng 2022; 19:10.1088/1741-2552/ac7e6c. [PMID: 35790135 PMCID: PMC11090244 DOI: 10.1088/1741-2552/ac7e6c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/05/2022] [Indexed: 11/12/2022]
Abstract
Objective.Therapeutic efficacy of deep brain stimulation (DBS) in both established and emerging indications, is highly dependent on accurate lead placement and optimized clinical programming. The latter relies on clinicians' experience to search among available sets of stimulation parameters and can be limited by the time constraints of clinical practice. Recent innovations in device technology have expanded the number of possible electrode configurations and parameter sets available to clinicians, amplifying the challenge of time constraints. We hypothesize that patient specific neuroimaging data can effectively assist the clinical programming using automated algorithms.Approach.This paper introduces the DBS Illumina 3D algorithm as a tool which uses patient-specific imaging to find stimulation settings that optimizes activating a target area while minimizing the stimulation of areas outside the target that could result in unknown or undesired side effects. This approach utilizes preoperative neuroimaging data paired with the postoperative reconstruction of the lead trajectory to search the available stimulation space and identify optimized stimulation parameters. We describe the application of this algorithm in three patients with treatment-resistant depression who underwent bilateral implantation of DBS in subcallosal cingulate cortex and ventral capsule/ventral striatum using tractography optimized targeting with an imaging defined target previously described.Main results.Compared to the stimulation settings selected by the clinicians (informed by anatomy), stimulation settings produced by the algorithm that achieved similar or greater target coverage, produced a significantly smaller stimulation area that spilled outside the target (P= 0.002).Significance. The DBS Illumina 3D algorithm is seamlessly integrated with the clinician programmer software and effectively and rapidly assists clinicians with the analysis of image based anatomy, and provides a starting point to search the highly complex stimulation parameter space and arrive at the stimulation settings that optimize activating a target area.
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Affiliation(s)
- Mahsa Malekmohammadi
- Boston Scientific Neuromodulation, 25155 Rye Canyon Loop, Valencia, CA 91355, USA
| | - Richard Mustakos
- Boston Scientific Neuromodulation, 25155 Rye Canyon Loop, Valencia, CA 91355, USA
| | - Sameer Sheth
- Department of Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Nader Pouratian
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, 8353 Harry Hines Blvd MC8855, Dallas, TX 75239, USA
| | - Cameron C. McIntyre
- Departments of Biomedical Engineering and Neurosurgery, Duke University, 100 Science Drive, Durham, NC 27708, USA
| | - Kelly R. Bijanki
- Department of Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Evangelia Tsolaki
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, 300 Stein Plaza Suite 562, Los Angeles, CA 90095, USA
| | - Kevin Chiu
- Brainlab, Inc., 5 Westbrook Corporate Center, Suite 1000, Westchester IL 60154, USA
| | - Meghan E. Robinson
- Department of Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Joshua A. Adkinson
- Department of Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Denise Oswalt
- Department of Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Stephen Carcieri
- Boston Scientific Neuromodulation, 25155 Rye Canyon Loop, Valencia, CA 91355, USA
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Lu Y, Chang L, Li J, Luo B, Dong W, Qiu C, Zhang W, Ruan Y. The Effects of Different Anesthesia Methods on the Treatment of Parkinson’s Disease by Bilateral Deep Brain Stimulation of the Subthalamic Nucleus. Front Neurosci 2022; 16:917752. [PMID: 35692425 PMCID: PMC9178204 DOI: 10.3389/fnins.2022.917752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background Subthalamic nucleus deep brain stimulation (STN–DBS) surgery for Parkinson’s disease (PD) is routinely performed at medical centers worldwide. However, it is debated whether general anesthesia (GA) or traditional local anesthetic (LA) is superior. Purpose This study aims to compare the effects of LA and GA operation methods on clinical improvement in patients with PD, such as motor and non-motor symptoms, after STN–DBS surgery at our center. Method A total of 157 patients with PD were retrospectively identified as having undergone surgery under LA (n = 81) or GA (n = 76) states. In this study, the Unified Parkinson’s Disease Rating Scale Motor Score (UPDRS-III) in three states, levodopa-equivalent-daily-dose (LEDD), surgical duration, intraoperative microelectrode recording (iMER) signal length, postoperative intracranial volume, electrode implantation error, neuropsychological function, quality of life scores, and complication rates were collected and compared. All patients with PD were routinely followed up at 6, 12, 18, and 24 months postoperatively. Result Overall improvement in UPDRS-III was demonstrated at postoperative follow-up, and there was no significant difference between the two groups in medication-off, stimulation-off state and medication-off, stimulation-on state. However, UPDRS-III scores in medication-on, stimulation-on state under GA was significantly lower than that in the LA group. During postoperative follow-up, LEDD in the LA group (6, 12, 18, and 24 months, postoperatively) was significantly lower than in the GA group. However, there were no significant differences at baseline or 1-month between the two groups. The GA group had a shorter surgical duration, lower intracranial volume, and longer iMER signal length than the LA group. However, there was no significant group difference in electrode implantation accuracy and complication rates. Additionally, the Hamilton Anxiety Scale (HAMA) was significantly lower in the GA group than the LA group at 1-month follow-up, but this difference disappeared at longer follow-up. Besides, there was no significant group difference in the 39-item Parkinson’s Disease Questionnaire (PDQ-39) scale scores. Conclusion Although both groups showed overall motor function improvement without a significant postoperative difference, the GA group seemed superior in surgical duration, intracranial volume, and iMER signal length. As the accuracy of electrode implantation can be ensured by iMER monitoring, DBS with GA will become more widely accepted.
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Affiliation(s)
- Yue Lu
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Lei Chang
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jinwen Li
- Department of Anesthesiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Bei Luo
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wenwen Dong
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chang Qiu
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wenbin Zhang
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Wenbin Zhang,
| | - Yifeng Ruan
- Department of Anesthesiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
- Yifeng Ruan,
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Wang S, Gong S, Tao Y, Liang G, Sha R, Xie A, Li Z, Yuan L. A Modified Power-on Programming Method after Deep Brain Stimulation for Parkinson Disease. World Neurosurg 2022; 160:e152-e158. [PMID: 34979288 DOI: 10.1016/j.wneu.2021.12.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/26/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the feasibility of using a modified power-on programming method in deep brain stimulation (DBS) for Parkinson disease (PD). METHODS We conducted a retrospective cohort study including 151 PD patients with bilateral robot-assisted DBS surgery from July 2017 to June 2020. Ninety-seven patients were adopted to the modified power-on programming method (Group I) and 54 patients were adopted to the traditional power-on programming method (Group II). In one-year follow-up, power-on programming duration, stimulation parameters, scores of Unified PD Rating Scale (UPDRS) and UPDRS-III of the 2 groups were recorded and compared. RESULTS There were no significant differences in the postoperative UPDRS, UPDRS-III improvement rate, and stimulation parameters between the 2 groups. The duration of power-on programming of Group I (1.7 ± 1.1 hours) was significantly less than that of Group II (3.5 ± 1.8 hours, P < 0.0001). CONCLUSIONS The modified power-on programming method can achieve a similar clinical effect to the traditional method, with the advantage of more efficiency.
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Affiliation(s)
- Shimiao Wang
- Department of Neurosurgery, The General Hospital of Northern Theater Command, Shenyang, China
| | - Shun Gong
- Department of Neurosurgery, The General Hospital of Northern Theater Command, Shenyang, China
| | - Yingqun Tao
- Department of Neurosurgery, The General Hospital of Northern Theater Command, Shenyang, China.
| | - Guobiao Liang
- Department of Neurosurgery, The General Hospital of Northern Theater Command, Shenyang, China
| | - Rong Sha
- Department of Neurosurgery, The General Hospital of Northern Theater Command, Shenyang, China
| | - Aotan Xie
- Department of Neurosurgery, The General Hospital of Northern Theater Command, Shenyang, China
| | - Zirui Li
- Department of Clinical Medicine (105K-Class 83), China Medical University, Shenyang, China
| | - Lijia Yuan
- Department of Neurosurgery, The General Hospital of Northern Theater Command, Shenyang, China
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Liang AS, Ginalis EE, Jani R, Hargreaves EL, Danish SF. Frameless Robotic-Assisted Deep Brain Stimulation With the Mazor Renaissance System. Oper Neurosurg (Hagerstown) 2021; 22:158-164. [DOI: 10.1227/ons.0000000000000050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022] Open
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Abstract
PURPOSE OF REVIEW Deep brain stimulation (DBS) is a rapidly expanding surgical modality for the treatment of patients with movement disorders. Its ability to be adjusted, titrated, and optimized over time has given it a significant advantage over traditional more invasive surgical procedures. Therefore, the success and popularity of this procedure have led to the discovery of new indications and therapeutic targets as well as advances in surgical techniques. The aim of this review is to highlight the important updates in DBS surgery and to exam the anesthesiologist's role in providing optimal clinical management. RECENT FINDINGS New therapeutic indications have a significant implication on perioperative anesthesia management. In addition, new technologies like frameless stereotaxy and intraoperative magnetic resonance imaging to guide electrode placement have altered the need for intraoperative neurophysiological monitoring and hence increased the use of general anesthesia. With an expanding number of patients undergoing DBS implantation, patients with preexisting DBS increasingly require anesthesia for unrelated surgery and the anesthesiologist must be aware of the considerations for perioperative management of these devices and potential complications. SUMMARY DBS will continue to grow and evolve requiring adaptation and modification to the anesthetic management of these patients.
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Affiliation(s)
- Michael Dinsmore
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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