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Lim ML, Zhan ABB, Liu SJ, Saffari SE, Li W, Teo MM, Wong TGL, Ng WH, Wan KR. Awake versus Asleep Anesthesia in Deep Brain Stimulation Surgery for Parkinson's Disease: A Systematic Review and Meta-Analysis. Stereotact Funct Neurosurg 2024; 102:141-155. [PMID: 38636468 DOI: 10.1159/000536310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/02/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Deep brain stimulation (DBS) is a well-established surgical therapy for patients with Parkinsons' Disease (PD). Traditionally, DBS surgery for PD is performed under local anesthesia, whereby the patient is awake to facilitate intraoperative neurophysiological confirmation of the intended target using microelectrode recordings. General anesthesia allows for improved patient comfort without sacrificing anatomic precision and clinical outcomes. METHODS We performed a systemic review and meta-analysis on patients undergoing DBS for PD. Published randomized controlled trials, prospective and retrospective studies, and case series which compared asleep and awake techniques for patients undergoing DBS for PD were included. A total of 19 studies and 1,900 patients were included in the analysis. RESULTS We analyzed the (i) clinical effectiveness - postoperative UPDRS III score, levodopa equivalent daily doses and DBS stimulation requirements. (ii) Surgical and anesthesia related complications, number of lead insertions and operative time (iii) patient's quality of life, mood and cognitive measures using PDQ-39, MDRS, and MMSE scores. There was no significant difference in results between the awake and asleep groups, other than for operative time, for which there was significant heterogeneity. CONCLUSION With the advent of newer technology, there is likely to have narrowing differences in outcomes between awake or asleep DBS. What would therefore be more important would be to consider the patient's comfort and clinical status as well as the operative team's familiarity with the procedure to ensure seamless transition and care.
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Affiliation(s)
- Michelle L Lim
- Department of Surgical Intensive Care, Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Anaesthesiology and Perioperative Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Angela B B Zhan
- Department of Nursing, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Sherry J Liu
- Department of Neurosurgery, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore, Singapore,
| | - Seyed E Saffari
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Wei Li
- Department of Nursing, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Mavis M Teo
- Department of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore
| | - Theodore G-L Wong
- Department of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore
| | - Wai H Ng
- Department of Neurosurgery, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Neurosurgery, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
| | - Kai R Wan
- Department of Neurosurgery, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Neurosurgery, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
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Cavallieri F, Mulroy E, Moro E. The history of deep brain stimulation. Parkinsonism Relat Disord 2024; 121:105980. [PMID: 38161106 DOI: 10.1016/j.parkreldis.2023.105980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
Deep brain stimulation (DBS) surgery is an established and effective treatment for several movement disorders (tremor, Parkinson's disease, and dystonia), and is under investigation in numerous other neurological and psychiatric disorders. However, the origins and development of this neurofunctional technique are not always well understood and recognized. In this mini-review, we review the history of DBS, highlighting important milestones and the most remarkable protagonists (neurosurgeons, neurologists, and neurophysiologists) who pioneered and fostered this therapy throughout the 20th and early 21st century. Alongside DBS historical markers, we also briefly discuss newer developments in the field, and the future challenges which accompany such progress.
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Affiliation(s)
- Francesco Cavallieri
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Elena Moro
- Grenoble Alpes University, Division of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble Institute of Neuroscience, INSERM U1216, Grenoble, France.
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Zhang DY, Pearce JJ, Petrosyan E, Borghei A, Byrne RW, Sani S. Minimizing pneumocephalus during deep brain stimulation surgery. Clin Neurol Neurosurg 2024; 238:108174. [PMID: 38422743 DOI: 10.1016/j.clineuro.2024.108174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Deep brain stimulation (DBS) surgery is an effective treatment for movement disorders. Introduction of intracranial air following dura opening in DBS surgery can result in targeting inaccuracy and suboptimal outcomes. We develop and evaluate a simple method to minimize pneumocephalus during DBS surgery. METHODS A retrospective analysis of prospectively collected data was performed on patients undergoing DBS surgery at our institution from 2014 to 2022. A total of 172 leads placed in 89 patients undergoing awake or asleep DBS surgery were analyzed. Pneumocephalus volume was compared between leads placed with PMT and leads placed with standard dural opening. (112 PMT vs. 60 OPEN). Immediate post-operative high-resolution CT scans were obtained for all leads placed, from which pneumocephalus volume was determined through a semi-automated protocol with ITK-SNAP software. Awake surgery was conducted with the head positioned at 15-30°, asleep surgery was conducted at 0°. RESULTS PMT reduced pneumocephalus from 11.2 cm3±9.2 to 0.8 cm3±1.8 (P<0.0001) in the first hemisphere and from 7.6 cm3 ± 8.4 to 0.43 cm3 ± 0.9 (P<0.0001) in the second hemisphere. No differences in adverse events were noted between PMT and control cases. Lower rates of post-operative headache were observed in PMT group. CONCLUSION We present and validate a simple yet efficacious technique to reduce pneumocephalus during DBS surgery.
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Affiliation(s)
- Daniel Y Zhang
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - John J Pearce
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Edgar Petrosyan
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Alireza Borghei
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Richard W Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA.
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Budnick HC, Schneider D, Zauber SE, Witt TC, Gupta K. Susceptibility-Weighted MRI Approximates Intraoperative Microelectrode Recording During Deep Brain Stimulation of the Subthalamic Nucleus for Parkinson's Disease. World Neurosurg 2024; 181:e346-e355. [PMID: 37839566 DOI: 10.1016/j.wneu.2023.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Deep brain stimulation of the subthalamic nucleus (STN-DBS) for Parkinson's disease can be performed with intraoperative neurophysiological and radiographic guidance. Conventional T2-weighted magnetic resonance imaging sequences, however, often fail to provide definitive borders of the STN. Novel magnetic resonance imaging sequences, such as susceptibility-weighted imaging (SWI), might better localize the STN borders and facilitate radiographic targeting. We compared the radiographic location of the dorsal and ventral borders of the STN using SWI with intraoperative microelectrode recording (MER) during awake STN-DBS for Parkinson's disease. METHODS Thirteen consecutive patients who underwent placement of 24 STN-DBS leads for Parkinson's disease were analyzed retrospectively. Preoperative targeting was performed with SWI, and MER data were obtained from intraoperative electrophysiology records. The boundaries of the STN on SWI were identified by a blinded investigator. RESULTS The final electrode position differed significantly from the planned coordinates in depth but not in length or width, indicating that MER guided the final electrode depth. When we compared the boundaries of the STN by MER and SWI, SWI accurately predicted the entry into the STN but underestimated the length and ventral boundary of the STN by 1.2 mm. This extent of error approximates the span of a DBS contact and could affect the placement of directional contacts within the STN. CONCLUSIONS MER might continue to have a role in STN-DBS. This could potentially be mitigated by further refinement of imaging protocols to better image the ventral boundary of the STN.
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Affiliation(s)
- Hailey C Budnick
- Department of Neurological Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Dylan Schneider
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - S Elizabeth Zauber
- Indiana University School of Medicine, Indianapolis, Indiana, USA; Department of Neurology, Indiana University, Indianapolis, Indiana, USA
| | - Thomas C Witt
- Department of Neurological Surgery, Indiana University, Indianapolis, Indiana, USA; Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kunal Gupta
- Department of Neurological Surgery, Indiana University, Indianapolis, Indiana, USA; Indiana University School of Medicine, Indianapolis, Indiana, USA; Stark Neurosciences Research Institute, Indiana University, Indianapolis, Indiana, USA; Department of Anatomy, Cell Biology & Physiology, Indiana University, Indianapolis, Indiana, USA; Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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5
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Paulo DL, Johnson GW, Doss DJ, Allen JH, González HFJ, Shults R, Li R, Ball TJ, Bick SK, Hassell TJ, D'Haese PF, Konrad PE, Dawant BM, Narasimhan S, Englot DJ. Intraoperative physiology augments atlas-based data in awake deep brain stimulation. J Neurol Neurosurg Psychiatry 2023; 95:86-96. [PMID: 37679029 PMCID: PMC11101241 DOI: 10.1136/jnnp-2023-331248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/25/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) is commonly performed with patients awake to perform intraoperative microelectrode recordings and/or macrostimulation testing to guide final electrode placement. Supplemental information from atlas-based databases derived from prior patient data and visualised as efficacy heat maps transformed and overlaid onto preoperative MRIs can be used to guide preoperative target planning and intraoperative final positioning. Our quantitative analysis of intraoperative testing and corresponding changes made to final electrode positioning aims to highlight the value of intraoperative neurophysiological testing paired with image-based data to optimise final electrode positioning in a large patient cohort. METHODS Data from 451 patients with movement disorders treated with 822 individual DBS leads at a single institution from 2011 to 2021 were included. Atlas-based data was used to guide surgical targeting. Intraoperative testing data and coordinate data were retrospectively obtained from a large patient database. Medical records were reviewed to obtain active contact usage and neurologist-defined outcomes at 1 year. RESULTS Microelectrode recording firing profiles differ per track, per target and inform the locations where macrostimulation testing is performed. Macrostimulation performance correlates with the final electrode track chosen. Centroids of atlas-based efficacy heat maps per target were close in proximity to and may predict active contact usage at 1 year. Overall, patient outcomes at 1 year were improved for patients with better macrostimulation response. CONCLUSIONS Atlas-based imaging data is beneficial for target planning and intraoperative guidance, and in conjunction with intraoperative neurophysiological testing during awake DBS can be used to individualize and optimise final electrode positioning, resulting in favourable outcomes.
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Affiliation(s)
- Danika L Paulo
- Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Graham W Johnson
- Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Derek J Doss
- Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jackson H Allen
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Hernán F J González
- Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Neurosurgery, UCSD, La Jolla, California, USA
| | - Robert Shults
- Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rui Li
- Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, USA
| | - Tyler J Ball
- Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah K Bick
- Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Travis J Hassell
- Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Pierre-François D'Haese
- Neuroradiology, West Virginia University Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA
| | - Peter E Konrad
- Neurosurgery, West Virginia University Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA
| | - Benoit M Dawant
- Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Saramati Narasimhan
- Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dario J Englot
- Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Wu B, Xu J, Zhang C, Ling Y, Yang C, Xuan R, Wang S, Guo Q, Zeng Z, Jiang N, Chen L, Liu J. The Effect of Surgical Positioning on Pneumocephalus in Subthalamic Nucleus Deep Brain Stimulation Surgery for Parkinson Disease. Neuromodulation 2023; 26:1714-1723. [PMID: 36272897 DOI: 10.1016/j.neurom.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/24/2022] [Accepted: 09/13/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This research analyzed the effect of surgical positioning on postoperative pneumocephalus and assessed additional potential risk factors of pneumocephalus in subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson disease (PD). MATERIALS AND METHODS In this study, 255 consecutive patients with PD who received bilateral STN DBS under general anesthesia were retrospectively included. Of these, 180 patients underwent surgery with their heads in an elevated position, and 75 patients underwent surgery in a supine position. The postoperative pneumocephalus volume was compared between the two groups. Other potential risk factors for pneumocephalus also were analyzed. RESULTS The mean pneumocephalus volume for the group with elevated-head positioning (16.76 ± 15.23 cm3) was greater than for the supine group (3.25 ± 8.78 cm3) (p < 0.001). Multivariable analysis indicated that the pneumocephalus volume was related to surgical positioning, lateral trajectory angle, intraoperative mean arterial pressure (MAP), microelectrode recording (MER) passage number, brain atrophy degree, and the anterior trajectory angle. No correlation was found between pneumocephalus and age, sex, duration of PD, surgery length, or intracranial volume. In the subgroup analysis, the pneumocephalus volume exhibited a negative correlation with intraoperative MAP (r = -0.210, p = 0.005) and positive correlations with degree of brain atrophy (r = 0.242, p = 0.001) and MER passage number (r = 0.184, p = 0.014) in the elevated-head group. Specifically, an MER passage number > 3 was a significant risk factor for pneumocephalus in the elevated-head group. A positive correlation was observed between the pneumocephalus volume and the lateral trajectory angle in both groups (elevated-head positioning, r = 0.153, p = 0.041; supine positioning, r = 0.546, p < 0.001). CONCLUSIONS In patients with PD who were anesthetized and receiving STN DBS, supine positioning reduced pneumocephalus volume compared with patients with PD receiving STN DBS with their heads elevated. The pneumocephalus volume was negatively correlated with intraoperative MAP and positively correlated with the degree of brain atrophy, the lateral trajectory angle, and the MER passage number.
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Affiliation(s)
- Bin Wu
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China; Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Jiakun Xu
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Changming Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Yuting Ling
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Chao Yang
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Ruoheng Xuan
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Simin Wang
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Qianqian Guo
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Zixia Zeng
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Nan Jiang
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Ling Chen
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Jinlong Liu
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China.
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7
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Pham TA, Dao PD, Nguyen LT, Le TV, Vo NT, Tran TN, Nguyen AM, Diem Nguyen TA, Binh Le KT. Accuracy of Subthalamic Nucleus Electrode Implantation in Deep Brain Stimulation Surgery for Parkinson's Disease Treatment and Affecting Factors: Outcomes at Two Centers in Vietnam. World Neurosurg 2023; 179:e32-e38. [PMID: 37356489 DOI: 10.1016/j.wneu.2023.06.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/17/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) surgery for Parkinson's Disease (PD) has become more and more popular in Vietnam. However, the accuracy of implantation and affecting factors are under investigation. The objective of this study is to evaluate the accuracy of the subthalamic nucleus (STN)-DBS electrode implantation technique for treatment PD at Nguyen Tri Phuong Hospital and University Medical Center. To investigate factors related to accuracy. METHODS We carried out a retrospective analysis of 58 patients with advanced PD who underwent STN-DBS surgery at Nguyen Tri Phuong Hospital and University Medical Center in Ho Chi Minh City, Viet Nam between June 2014 and July 2021 (115 leads total). All patients underwent the procedure with standard frame-based techniques under local anesthesia with microelectrode recording and macrostimuation test. RESULTS Twenty-six female (44.8%) and thirty-two male (55.2%) patients with a mean age of 60.4 ± 8.3 years old (40-76 years) were included. Of total of 115 electrodes implanted, the mean target error (ΔT), radial error (ΔR), angle error (Δθ) were 1.94 ± 0.73 mm; 1.16 ± 0.69 mm; 2.22 ± 4.24 degrees, respectively. Vector error on each coordinate axis ΔX, ΔY, ΔZ were -0.35 ± 1.02 mm, +0.99 ± 0.82 mm, +0.73 ± 0.99 mm, respectively. There was a statistically significant correlation between subdural air volume, cortical shift, intracranial electrode bending, and accuracy. CONCLUSIONS The current STN-DBS electrode implantation technique applied in our centers was quite accurate with acceptable error. More clinical trials are necessary to directly compare affecting factors to the accuracy of electrode implantation.
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Affiliation(s)
- Tuan Anh Pham
- Department of Neurosurgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam; Department of Neurosurgery, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
| | - Phuong Duy Dao
- Department of Neurosurgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam; Department of Neurosurgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam.
| | - Lam Thanh Nguyen
- Departments of Neurosurgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thang Viet Le
- Department of Neurosurgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam; Departments of Neurosurgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nghia Thanh Vo
- Department of Neurosurgery, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam; Department of Anatomy, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tai Ngoc Tran
- Movement Disorders Unit, Department of Neurology, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Anh Minh Nguyen
- Department of Neurosurgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam; Departments of Neurosurgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | - Khang Thai Binh Le
- Department of Neurosurgery, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
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Iess G, Bonomo G, Levi V, Aquino D, Zekaj E, Mezza F, Servello D. MER and increased operative time are not risk factors for the formation of pneumocephalus during DBS. Sci Rep 2023; 13:9324. [PMID: 37291256 PMCID: PMC10250399 DOI: 10.1038/s41598-023-30289-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/21/2023] [Indexed: 06/10/2023] Open
Abstract
Although only recently directional leads have proven their potential to compensate for sub-optimally placed electrodes, optimal lead positioning remains the most critical factor in determining Deep Brain Stimulation (DBS) outcome. Pneumocephalus is a recognized source of error, but the factors that contribute to its formation are still a matter of debate. Among these, operative time is one of the most controversial. Because cases of DBS performed with Microelectrode Recordings (MER) are affected by an increase in surgical length, it is useful to analyze whether MER places patients at risk for increased intracranial air entry. Data of 94 patients from two different institutes who underwent DBS for different neurologic and psychiatric conditions were analyzed for the presence of postoperative pneumocephalus. Operative time and use of MER, as well as other potential risk factors for pneumocephalus (age, awake vs. asleep surgery, number of MER passages, burr hole size, target and unilateral vs. bilateral implants) were examined. Mann-Whitney U and Kruskal-Wallis tests were utilized to compare intracranial air distributions across groups of categorical variables. Partial correlations were used to assess the association between time and volume. A generalized linear model was created to predict the effects of time and MER on the volume of intracranial air, controlling for other potential risk factors identified: age, number of MER passages, awake vs. asleep surgery, burr hole size, target, unilateral vs. bilateral surgery. Significantly different distributions of air volume were noted between different targets, unilateral vs. bilateral implants, and number of MER trajectories. Patients undergoing DBS with MER did not present a significant increase in pneumocephalus compared to patients operated without (p = 0.067). No significant correlation was found between pneumocephalus and time. Using multivariate analysis, unilateral implants exhibited lower volumes of pneumocephalus (p = 0.002). Two specific targets exhibited significantly different volumes of pneumocephalus: the bed nucleus of the stria terminalis with lower volumes (p < 0.001) and the posterior hypothalamus with higher volumes (p = 0.011). MER, time, and other parameters analyzed failed to reach statistical significance. Operative time and use of intraoperative MER are not significant predictors of pneumocephalus during DBS. Air entry is greater for bilateral surgeries and may be also influenced by the specific stimulated target.
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Affiliation(s)
- Guglielmo Iess
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
- Università degli Studi di Milano, Milan, Italy.
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Levi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Domenico Aquino
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Edvin Zekaj
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Federica Mezza
- Department of Economics, University of California, Los Angeles, USA
| | - Domenico Servello
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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9
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Fan S, Zhang Q, Meng F, Fang H, Yang G, Shi Z, Liu H, Zhang H, Yang A, Zhang J, Shi L. Comparison of dural puncture and dural incision in deep brain stimulation surgery: A simple but worthwhile technique modification. Front Neurosci 2022; 16:988661. [PMID: 36408391 PMCID: PMC9669717 DOI: 10.3389/fnins.2022.988661] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Background The accuracy of the deep brain stimulation (DBS) electrode placement is influenced by a myriad of factors, among which pneumocephalus and loss of cerebrospinal fluid that occurs with dural opening during the surgery are considered most important. This study aimed to describe an effective method for decreasing pneumocephalus by comparing its clinical efficacy between the two different methods of opening the dura. Materials and methods We retrospectively compared two different methods of opening the dura in 108 patients who underwent bilateral DBS surgery in our center. The dural incision group comprised 125 hemispheres (58 bilateral and 9 unilateral) and the dural puncture group comprised 91 (41 bilateral and 9 unilateral). The volume of intracranial air, dural opening time, intraoperative microelectrode recordings (MERs), postoperative electrode displacement, clinical efficacy, and complications were examined. Spearman correlation analysis was employed to identify factors associated with the volume of intracranial air and postoperative electrode displacement. Results The volume of intracranial air was significantly lower (0.35 cm3 vs. 5.90 cm3) and dural opening time was significantly shorter (11s vs. 35s) in the dural puncture group. The volume of intracranial air positively correlated with dural opening time. During surgery, the sensorimotor area was longer (2.47 ± 1.36 mm vs. 1.92 ± 1.42 mm) and MERs were more stable (81.82% vs. 47.73%) in the dural puncture group. Length of the sensorimotor area correlated negatively with the volume of intracranial air. As intracranial air was absorbed after surgery, significant anterior, lateral, and ventral electrode displacement occurred; the differences between the two groups were significant (total electrode displacement, 1.0mm vs. 1.4mm). Electrode displacement correlated positively with the volume of intracranial air. Clinical efficacy was better in the dural puncture group than the dural incision group (52.37% ± 16.18% vs. 43.93% ± 24.50%), although the difference was not significant. Conclusion Our data support the hypothesis that opening the dura via puncture rather than incision when performing DBS surgery reduces pneumocephalus, shortens dural opening time, enables longer sensorimotor area and more stable MERs, minimizes postoperative electrode displacement, and may permit a better clinical efficacy.
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Affiliation(s)
- Shiying Fan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Quan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fangang Meng
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Huaying Fang
- Beijing Advanced Innovation Center for Imaging Theory and Technology, Capital Normal University, Beijing, China
- Academy for Multidisciplinary Studies, Capital Normal University, Beijing, China
| | - Guang Yang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhongjie Shi
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Huanguang Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hua Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anchao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Jianguo Zhang,
| | - Lin Shi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Lin Shi,
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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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11
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Vesper J, Mainzer B, Senemmar F, Schnitzler A, Groiss SJ, Slotty PJ. Anesthesia for deep brain stimulation system implantation: adapted protocol for awake and asleep surgery using microelectrode recordings. Acta Neurochir (Wien) 2022; 164:1175-1182. [PMID: 35212799 PMCID: PMC8967743 DOI: 10.1007/s00701-021-05108-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/28/2021] [Indexed: 11/27/2022]
Abstract
Purpose Deep brain stimulation (DBS), an effective treatment for movement disorders, usually involves lead implantation while the patient is awake and sedated. Recently, there has been interest in performing the procedure under general anesthesia (asleep). This report of a consecutive cohort of DBS patients describes anesthesia protocols for both awake and asleep procedures. Methods Consecutive patients with Parkinson’s disease received subthalamic nucleus (STN) implants either moderately sedated or while intubated, using propofol and remifentanil. Microelectrode recordings were performed with up to five trajectories after discontinuing sedation in the awake group, or reducing sedation in the asleep group. Clinical outcome was compared between groups with the UPDRS III. Results The awake group (n = 17) received 3.5 mg/kg/h propofol and 11.6 μg/kg/h remifentanil. During recording, all anesthesia was stopped. The asleep group (n = 63) initially received 6.9 mg/kg/h propofol and 31.3 μg/kg/h remifentanil. During recording, this was reduced to 3.1 mg/kg/h propofol and 10.8 μg/kg/h remifentanil. Without parkinsonian medications or stimulation, 3-month UPDRS III ratings (ns = 16 and 52) were 40.8 in the awake group and 41.4 in the asleep group. Without medications but with stimulation turned on, ratings improved to 26.5 in the awake group and 26.3 in the asleep group. With both medications and stimulation, ratings improved further to 17.6 in the awake group and 15.3 in the asleep group. All within-group improvements from the off/off condition were statistically significant (all ps < 0.01). The degree of improvement with stimulation, with or without medications, was not significantly different in the awake vs. asleep groups (ps > 0.05). Conclusion The above anesthesia protocols make possible an asleep implant procedure that can incorporate sufficient microelectrode recording. Together, this may increase patient comfort and improve clinical outcomes.
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Affiliation(s)
- Jan Vesper
- Department of Functional Neurosurgery and Stereotaxy, Medical Faculty, Heinrich-Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Bernd Mainzer
- Department of Anesthesia and Intensive Care Medicine, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Farhad Senemmar
- Department of Neurology & Institute for Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Alfons Schnitzler
- Department of Neurology & Institute for Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Stefan Jun Groiss
- Department of Neurology & Institute for Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Philipp J Slotty
- Department of Functional Neurosurgery and Stereotaxy, Medical Faculty, Heinrich-Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
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12
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Feng L, Liu Y, Tang H, Ling Z, Xu L, Yuan W, Feng Z. Delayed Recovery After Deep Brain Stimulation Surgery for Parkinson's Disease Under General Anesthesia-Cases Report. Front Surg 2022; 9:811337. [PMID: 35300247 PMCID: PMC8921249 DOI: 10.3389/fsurg.2022.811337] [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: 11/08/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Parkinson's disease (PD) is a neurodegenerative syndrome, and deep-brain stimulation (DBS) is an effective therapy for carefully screened patients with PD. However, delayed recovery after anesthesia, which occurs after taking prolonged general anesthesia for such patients, has been reported less frequently in literature. This report explores the possible causes of postoperative awakening delay in patients undergoing DBS surgery due to general anesthesia and provides a reference for anesthesia management of similar operations in the future. Case Presentation Three patients with PD elective underwent DBS surgery. The first patients demonstrated walking disability, gait deficits, unstable posture, limb stiffness, and imbalance. The second demonstrated left limb static tremor, stiffness, and bradykinesia. The third demonstrated bradykinesia, rigidity, walking deficits, and decreased facial expression. These included two males and one female with a mean patient age of 60.7 ± 6.7year, weight of 63.7 ± 11 kg, the height of 163.3 ± 7.6 cm, and preoperative American Society of Anesthesiology rating of 2.3 ± 0.6. The preoperative Glasgow Coma Scale mean score was 15. All patients completed the operation under general anesthesia (the mean anesthesia time was 5.3 ± 1.1 h). The mean operation time was 252 ± 60 min. The mean bleeding volume was 50 ml, and the urine volume was 867 ± 569 ml. However, all the patients showed unconsciousness after 95 ± 22 min after stopping the anesthetic, and the respiratory function was in good condition, but they could not cooperate with anesthesiologists and had no response to the anesthesiologist's instructions. The mean hospital stay was 17 ± 7 days. All patients were discharged uneventfully. The average number of days patients followed up postoperatively was 171 ± 28.5 days. Motor and speech were improved significantly postoperatively in three patients compared with preoperatively. Taking anti-Parkinson medication was markedly reduced. There were no complications during postoperative follow-up. Conclusions To prevent delayed recovery occurring after DBS surgery in Parkinson's disease, it is recommended to take scalp nerve block + general anesthesia to complete the procedure while avoiding general anesthesia.
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Affiliation(s)
- Long Feng
- Department of Anesthesiology, Hainan Hospital of Chinese People's Liberation Army (PLA) General Hospital, Sanya, China
| | - Yaohong Liu
- Department of Anesthesiology, Hainan Hospital of Chinese People's Liberation Army (PLA) General Hospital, Sanya, China
| | - Hao Tang
- Department of Neurosurgery, Hainan Hospital of Chinese People's Liberation Army (PLA) General Hospital, Sanya, China
| | - Zhipei Ling
- Department of Anesthesiology, Hainan Hospital of Chinese People's Liberation Army (PLA) General Hospital, Sanya, China
- Zhipei Ling
| | - Longhe Xu
- Department of Anesthesiology, The Third Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Longhe Xu
| | - Weixiu Yuan
- Department of Anesthesiology, Hainan Hospital of Chinese People's Liberation Army (PLA) General Hospital, Sanya, China
- Weixiu Yuan
| | - Zeguo Feng
- Department of Pain, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Zeguo Feng
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13
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Wu YX, Xiang W, Wang JJ, Liu XM, Yi DY, Tian H, Zhao HY, Jiang XB, Fu P. A Modified Dura Puncture Procedure to Reduce Brain Shift in Deep Brain Stimulation Surgery: One Institution's Experience. Front Neurol 2022; 13:845926. [PMID: 35295828 PMCID: PMC8920348 DOI: 10.3389/fneur.2022.845926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/31/2022] [Indexed: 11/15/2022] Open
Abstract
Objective The therapeutic effect of deep brain stimulation (DBS) surgery mainly depends on the accuracy of electrode placement and the reduction in brain shift. Among the standard procedures, cerebrospinal fluid (CSF) loss or pneumocephalus caused by dura incision (DI) is thought to be the main reason for brain shift and inaccuracy of electrode placement. In the current study, we described a modified dura puncture (DP) procedure to reduce brain shift and compare it with the general procedure of DBS surgery in terms of electrode placement accuracy. Materials and Methods We retrospectively analyzed a series of 132 patients who underwent DBS surgery in Wuhan Union Hospital from December 2015 to April 2021. According to the different surgery procedures, patients were classified into two cohorts: the DI group (DI cohort) had 49 patients who receive the general procedure, and the DP group (DP cohort) had 83 patients who receive the modified procedure. Postoperative pneumocephalus volume (PPV) and CSF loss volume, electrode fusion error (EFE), and trajectory number were calculated. Meanwhile, intraoperative electrophysiological signal length (IESL), electrode implantation duration, and other parameters were analyzed. Results In the current study, we introduced an improved electrode implantation procedure for DBS surgery named the DP procedure. Compared with the general DI cohort (n = 49), the modified DP cohort (n = 83) had a shorter electrode implantation duration (p < 0.0001), smaller PPV, lower CSF leakage volume (p < 0.0001), and smaller EFE (p < 0.0001). There was no significant difference in IESL (p > 0.05) or adverse events (perioperative cerebral haematoma, skin erosion, epilepsy, p > 0.05) between the two cohorts. Conclusion The DP procedure is a modified procedure that can reduce brain shift and ensure implantation accuracy during DBS surgery without adverse events.
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Affiliation(s)
- Yu-Xi Wu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Xiang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia-Jing Wang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Ming Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dong-Ye Yi
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Han Tian
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong-Yang Zhao
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Bing Jiang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Fu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Peng Fu
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Role of Directional Configuration in Deep Brain Stimulation for Essential Tremor: A Single Center Experience. Tremor Other Hyperkinet Mov (N Y) 2021; 11:47. [PMID: 34824890 PMCID: PMC8588889 DOI: 10.5334/tohm.628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/02/2021] [Indexed: 11/20/2022] Open
Abstract
Background Traditionally, the standard of care for medication refractory essential tremor has been to utilize omnidirectional deep brain stimulation of the ventral intermediate nucleus. The advent of directional stimulation allows for spatial restriction of the stimulation on selected targets without involving the neighboring structures, thereby limiting off-target side effects and improving clinical utility. Methods We performed a retrospective review of patients between February 2017 and September 2019 who had received ventral intermediate nucleus deep brain stimulation that allowed for directional programming (specifically Abbott/St. Jude). Initial and final major programming sessions post-operatively (approximately 30- and 90-days post-surgery) were examined to determine frequency and reason for use of directional programming. Results A total of 33 total patients were identified. A little over half were males (58%, N = 19), with an average age of 68 years old (SD 9.3) at the time of surgery, and a disease duration of almost 30 years (27.2, SD 19) with a wide range from 2-62 years. After initial programming, over 50% (17 of 33) of patients were using directional configurations. This increased to 85% (28 of 33) at the 90-day programming. Reasons for conversion to directional configuration included avoidance of side effects (specifically, muscle contractions (9/33), paresthesia (5/33), dysarthria (1/33) and gait ataxia (1/33)) or improved tremor control (12/33). Discussion Our single-center experience suggests that in the large majority of cases, directional leads were utilized and offered advantages in tremor control or side effect avoidance.
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15
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Segar DJ, Tata N, Harary M, Hayes MT, Cosgrove GR. Asleep deep brain stimulation with intraoperative magnetic resonance guidance: a single-institution experience. J Neurosurg 2021; 136:699-708. [PMID: 34359029 DOI: 10.3171/2020.12.jns202572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 12/15/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is traditionally performed on an awake patient with intraoperative recordings and test stimulation. DBS performed under general anesthesia with intraoperative MRI (iMRI) has demonstrated high target accuracy, reduced operative time, direct confirmation of target placement, and the ability to place electrodes without cessation of medications. The authors describe their initial experience with using iMRI to perform asleep DBS and discuss the procedural and radiological outcomes of this procedure. METHODS All DBS electrodes were implanted under general anesthesia by a single surgeon by using a neuronavigation system with 3-T iMRI guidance. Clinical outcomes, operative duration, complications, and accuracy were retrospectively analyzed. RESULTS In total, 103 patients treated from 2015 to 2019 were included, and all but 1 patient underwent bilateral implantation. Indications included Parkinson's disease (PD) (65% of patients), essential tremor (ET) (29%), dystonia (5%), and refractory epilepsy (1%). Targets included the globus pallidus pars internus (12.62% of patients), subthalamic nucleus (56.31%), ventral intermedius nucleus of the thalamus (30%), and anterior nucleus of the thalamus (1%). Technically accurate lead placement (radial error ≤ 1 mm) was obtained for 98% of leads, with a mean (95% CI) radial error of 0.50 (0.46-0.54) mm; all leads were placed with a single pass. Predicted radial error was an excellent predictor of real radial error, underestimating real error by only a mean (95% CI) of 0.16 (0.12-0.20) mm. Accuracy remained high irrespective of surgeon experience, but procedure time decreased significantly with increasing institutional and surgeon experience (p = 0.007), with a mean procedure duration of 3.65 hours. Complications included 1 case of intracranial hemorrhage (asymptomatic) and 1 case of venous infarction (symptomatic), and 2 patients had infection at the internal pulse generator site. The mean ± SD voltage was 2.92 ± 0.83 V bilaterally at 1-year follow-up. Analysis of long-term clinical efficacy demonstrated consistent postoperative improvement in clinical symptoms, as well as decreased drug doses across all indications and follow-up time points, including mean decrease in levodopa-equivalent daily dose by 53.57% (p < 0.0001) in PD patients and mean decrease in primidone dose by 61.33% (p < 0.032) in ET patients at 1-year follow-up. CONCLUSIONS A total of 205 leads were placed in 103 patients by a single surgeon under iMRI guidance with few operative complications. Operative time trended downward with increasing institutional experience, and technical accuracy of radiographic lead placement was consistently high. Asleep DBS implantation with iMRI appears to be a safe and effective alternative to standard awake procedures.
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Affiliation(s)
| | - Nalini Tata
- Departments of1Neurosurgery and.,4Department of Neurosurgery, UCLA, Los Angeles, California
| | - Maya Harary
- Departments of1Neurosurgery and.,3Northwestern Feinberg School of Medicine, Chicago, Illinois; and
| | - Michael T Hayes
- 2Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Atsumi H, Matsumae M. Fusing of Preoperative Magnetic Resonance and Intraoperative O-arm Images in Deep Brain Stimulation Enhance Intuitive Surgical Planning and Increase Accuracy of Lead Placement. Neurol Med Chir (Tokyo) 2021; 61:341-346. [PMID: 33790132 PMCID: PMC8120096 DOI: 10.2176/nmc.tn.2020-0317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
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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Affiliation(s)
- Hideki Atsumi
- Department of Neurosurgery, Tokai University School of Medicine
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17
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Holland MT, Mansfield K, Mitchell A, Burchiel KJ. Hidden Error in Optical Stereotactic Navigation Systems and Strategy to Maximize Accuracy. Stereotact Funct Neurosurg 2021; 99:369-376. [PMID: 33744897 DOI: 10.1159/000514053] [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: 10/15/2020] [Accepted: 12/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Optical neuronavigation has been established as a reliable and effective adjunct to many neurosurgical procedures. Operations such as asleep deep brain stimulation (aDBS) benefit from the potential increase in accuracy that these systems offer. Built into these technologies is a degree of tolerated error that may exceed the presumed accuracy resulting in suboptimal outcomes. OBJECTIVE The objective of this study was to identify an underlying source of error in neuronavigation and determine strategies to maximize accuracy. METHODS A Medtronic Stealth system (Stealth Station 7 hardware, S8 software, version 3.1.1) was used to simulate an aDBS procedure with the Medtronic Nexframe system. Multiple configurations and orientations of the Nexframe-Nexprobe system components were examined to determine potential sources of, and to quantify navigational error, in the optical navigation system. Virtual entry point and target variations were recorded and analyzed. Finally, off-plan error was recorded with the AxiEM system and visual observation on a phantom head. RESULTS The most significant source of error was found to be the orientation of the reference marker plate configurations to the camera system, with the presentation of the markers perpendicular to the camera line of site being the most accurate position. Entry point errors ranged between 0.134 ± 0.048 and 1.271 ± 0.0986 mm in a complex, reproducible pattern dependent on the orientation of the Nexprobe reference plate. Target errors ranged between 0.311 ± 0.094 and 2.159 ± 0.190 mm with a similarly complex, repeatable pattern. Representative configurations were tested for physical error at target with errors ranging from 1.2 mm to 1.4 mm. Throughout data acquisition, no orientation was indicated as outside the acceptable tolerance by the Stealth software. CONCLUSIONS Use of optical neuronavigation is expected to increase in frequency and variety of indications. Successful implementation of this technology depends on understanding the tolerances built into the system. In situations that depend on extremely high precision, surgeons should familiarize themselves with potential sources of error so that systems may be optimized beyond the manufacturer's built-in tolerances. We recommend that surgeons align the navigation reference plate and any optical instrument's reference plate spheres in the plane perpendicular to the line of site of the camera to maximize accuracy.
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Affiliation(s)
- Marshall T Holland
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Ann Mitchell
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Kim J Burchiel
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA,
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Krauss P, Van Niftrik CHB, Muscas G, Scheffler P, Oertel MF, Stieglitz LH. How to avoid pneumocephalus in deep brain stimulation surgery? Analysis of potential risk factors in a series of 100 consecutive patients. Acta Neurochir (Wien) 2021; 163:177-184. [PMID: 32960362 DOI: 10.1007/s00701-020-04588-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Accuracy of lead placement is the key to success in deep brain stimulation (DBS). Precise anatomic stereotactic planning usually is based on stable perioperative anatomy. Pneumocephalus due to intraoperative CSF loss is a common procedure-related phenomenon which could lead to brain shift and targeting inaccuracy. The aim of this study was to evaluate potential risk factors of pneumocephalus in DBS surgery. METHODS We performed a retrospective single-center analysis in patients undergoing bilateral DBS. We quantified the amount of pneumocephalus by postoperative CT scans and corrected the data for accompanying brain atrophy by an MRI-based score. Automated computerized segmentation algorithms from a dedicated software were used. As potential risk factors, we evaluated the impact of trephination size, the number of electrode tracks, length of surgery, intraoperative blood pressure, and brain atrophy. RESULTS We included 100 consecutive patients that underwent awake DBS with intraoperative neurophysiological testing. Systolic and mean arterial blood pressure showed a substantial impact with an inverse correlation, indicating that lower blood pressure is associated with higher volume of pneumocephalus. Furthermore, the length of surgery was clearly correlated to pneumocephalus. CONCLUSION Our analysis identifies intraoperative systolic and mean arterial blood pressure as important risk factors for pneumocephalus in awake stereotactic surgery.
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Affiliation(s)
- Philipp Krauss
- Department of Neurosurgery, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Christiaan Hendrik Bas Van Niftrik
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
| | - Giovanni Muscas
- Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
- Department of Neurosurgery, Careggi University Hospital Florence, Florence, Italy
| | - Pierre Scheffler
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
| | - Markus Florian Oertel
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
| | - Lennart Henning Stieglitz
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
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Piacentino M, Beggio G, Rustemi O, Zambon G, Pilleri M, Raneri F. Pneumocephalus in subthalamic deep brain stimulation for Parkinson's disease: a comparison of two different surgical techniques considering factors conditioning brain shift and target precision. Acta Neurochir (Wien) 2021; 163:169-175. [PMID: 33174114 DOI: 10.1007/s00701-020-04635-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Precise placement of electrodes in deep brain stimulation (DBS) may be influenced by brain shift caused by cerebrospinal fluid leaking or air inflow. We compared accuracy and treatment outcomes between a standard technique and one aiming at reducing brain shift. METHODS We retrospectively reviewed 46 patients (92 targets) treated with bilateral subthalamic-DBS for Parkinson's disease. The patients were divided into two groups: group A surgery was performed in supine position with standard burr hole, dural opening, fibrin glue and gelfoam plugging. Group B patients were operated in a semi-sitting position with direct dural puncture to reduce CSF loss. We analysed target deviation on head CT performed immediately after surgery and at 1 month merged with preoperative MRI planning. We recorded pneumocephalus volume, brain atrophy and target correction by intraoperative neurophysiology (ION). RESULTS In group A, the mean pneumocephalus volume was 10.55 cm3, mean brain volume 1116 cm3, mean target deviation 1.09 mm and ION corrected 70% of targets. In group B, mean pneumocephalus was 7.60 cm3 (p = 0.3048), mean brain volume 1132 cm3 (p = 0.6526), mean target deviation 0.64 mm (p = 0.0074) and ION corrected 50% of targets (p = 0.4886). Most leads' deviations realigned to the planned target after pneumocephalus reabsorbtion suggesting a deviation caused by displacement of anatomical structures due to brain shift. Definitive lead position was always decided with ION. CONCLUSIONS The modified DBS technique significantly reduced errors of electrode placement, though such difference was clinically irrelevant. ION corrected a high amount of trajectories in both groups (70% vs 50%). The choice of either strategy is acceptable.
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Affiliation(s)
- Massimo Piacentino
- Department of Neurosurgery, AULSS 8 Berica Ospedale San Bortolo, Viale Rodolfi, 37 36100, Vicenza, Italy
| | - Giacomo Beggio
- Department of Neurosurgery, AULSS 8 Berica Ospedale San Bortolo, Viale Rodolfi, 37 36100, Vicenza, Italy
| | - Oriela Rustemi
- Department of Neurosurgery, AULSS 8 Berica Ospedale San Bortolo, Viale Rodolfi, 37 36100, Vicenza, Italy
| | - Giampaolo Zambon
- Department of Neurosurgery, AULSS 8 Berica Ospedale San Bortolo, Viale Rodolfi, 37 36100, Vicenza, Italy
| | - Manuela Pilleri
- Department of Neurology, Casa di Cura Villa Margherita Hospital, Via Costa Colonna, 6 36057, Arcugnano, Italy
| | - Fabio Raneri
- Department of Neurosurgery, AULSS 8 Berica Ospedale San Bortolo, Viale Rodolfi, 37 36100, Vicenza, Italy.
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Jin H, Gong S, Tao Y, Huo H, Sun X, Song D, Xu M, Xu Z, Liu Y, Wang S, Yuan L, Wang T, Song W, Pan H. A comparative study of asleep and awake deep brain stimulation robot-assisted surgery for Parkinson's disease. NPJ PARKINSONS DISEASE 2020; 6:27. [PMID: 33083521 PMCID: PMC7536209 DOI: 10.1038/s41531-020-00130-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 09/02/2020] [Indexed: 01/13/2023]
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.
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Affiliation(s)
- Hai Jin
- Department of Neurosurgery, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Shun Gong
- Department of Neurosurgery, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Yingqun Tao
- Department of Neurosurgery, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Hua Huo
- Department of Clinical Trail Management Agency, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Xiao Sun
- Department of Neurosurgery, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Dandan Song
- Department of Anesthesia, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Ming Xu
- Department of Anesthesia, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Zhaozhu Xu
- Department of Anesthesia, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Yang Liu
- Department of Neurosurgery, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Shimiao Wang
- Department of Neurosurgery, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Lijia Yuan
- Department of Neurosurgery, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Tingting Wang
- Department of Neurosurgery, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Weilong Song
- Department of Neurosurgery, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - He Pan
- Department of Neurosurgery, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
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Park HR, Lim YH, Song EJ, Lee JM, Park K, Park KH, Lee WW, Kim HJ, Jeon B, Paek SH. Bilateral Subthalamic Nucleus Deep Brain Stimulation under General Anesthesia: Literature Review and Single Center Experience. J Clin Med 2020; 9:jcm9093044. [PMID: 32967337 PMCID: PMC7564882 DOI: 10.3390/jcm9093044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/13/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023] Open
Abstract
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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Affiliation(s)
- Hye Ran Park
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea;
| | - Yong Hoon Lim
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea; (Y.H.L.); (E.J.S.)
| | - Eun Jin Song
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea; (Y.H.L.); (E.J.S.)
| | - Jae Meen Lee
- Department of Neurosurgery, Pusan National University Hospital, Busan 49241, Korea;
| | - Kawngwoo Park
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon 21565, Korea;
| | - Kwang Hyon Park
- Department of Neurosurgery, Chuungnam National University Sejong Hospital, Sejong 30099, Korea;
| | - Woong-Woo Lee
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Korea;
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul 03080, Korea; (H.-J.K.); (B.J.)
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul 03080, Korea; (H.-J.K.); (B.J.)
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea; (Y.H.L.); (E.J.S.)
- Correspondence: ; Tel.: +82-22-072-2876
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Zsigmond P, Wårdell K. Optical Measurements during Asleep Deep Brain Stimulation Surgery along Vim-Zi Trajectories. Stereotact Funct Neurosurg 2020; 98:55-61. [PMID: 32079023 DOI: 10.1159/000505708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/31/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Optics can be used for guidance in deep brain stimulation (DBS) surgery. The aim was to use laser Doppler flowmetry (LDF) to investigate the intraoperative optical trajectory along the ventral intermediate nucleus (VIM) and zona incerta (Zi) regions in patients with essential tremor during asleep DBS surgery, and whether the Zi region could be identified. METHODS A forward-looking LDF guide was used for creation of the trajectory for the DBS lead, and the microcirculation and tissue greyness, i.e., total light intensity (TLI) was measured along 13 trajectories. TLI trajectories and the number of high-perfusion spots were investigated at 0.5-mm resolution in the last 25 mm from the targets. RESULTS All implantations were done without complications and with significant improvement of tremor (p < 0.01). Out of 798 measurements, 12 tissue spots showed high blood flow. The blood flow was significantly higher in VIM than in Zi (p < 0.001). The normalized mean TLI curve showed a significant (p < 0.001) lower TLI in the VIM region than in the Zi region. CONCLUSION Zi DBS performed asleep appears to be safe and effective. LDF monitoring provides direct in vivomeasurement of the microvascular blood flow in front of the probe, which can help reduce the risk of hemorrhage. LDF can differentiate between the grey substance in the thalamus and the transmission border entering the posterior subthalamic area where the tissue consists of more white matter tracts.
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Affiliation(s)
- Peter Zsigmond
- Departments of Neurosurgery and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden,
| | - Karin Wårdell
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
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Albano L, Rohatgi P, Kashanian A, Bari A, Pouratian N. Symptomatic Pneumocephalus after Deep Brain Stimulation Surgery: Report of 2 Cases. Stereotact Funct Neurosurg 2020; 98:30-36. [DOI: 10.1159/000505078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/22/2019] [Indexed: 11/19/2022]
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Liu Z, He S, Li L. General Anesthesia versus Local Anesthesia for Deep Brain Stimulation in Parkinson’s Disease: A Meta-Analysis. Stereotact Funct Neurosurg 2020; 97:381-390. [DOI: 10.1159/000505079] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/22/2019] [Indexed: 11/19/2022]
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Beggio G, Raneri F, Rustemi O, Scerrati A, Zambon G, Piacentino M. Techniques for pneumocephalus and brain shift reduction in DBS surgery: a review of the literature. Neurosurg Rev 2020; 43:95-99. [PMID: 31897886 DOI: 10.1007/s10143-019-01220-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/22/2019] [Accepted: 12/02/2019] [Indexed: 01/19/2023]
Abstract
Deep brain stimulation has become an established therapeutic choice to manage the symptoms of medically refractory Parkinson's disease. Its efficacy is highly dependent on the accuracy of electrodes' positioning in the correct anatomical target. During DBS procedure, the opening of the dura mater induces the displacement of neural structures. This effect mainly depends on the loss of the physiological negative intracranial pressure, air inflow, and loss of cerebrospinal fluid. Several studies concentrated on correcting surgical techniques for DBS electrodes' positioning in order to reduce pneumocephalus which may result in therapeutic failure. The authors focused in particular on reducing the brain air window and maintaining the pressure gradient between intra- and extracranial compartments. A significant reduction of pneumocephalus and brain shift was obtained by excluding the opening of the subarachnoid space, by covering the dura mater opening with tissue sealant and by reducing the intracranial pressure in general anesthesia. Smaller burr hole diameters were not statistically relevant for reducing air inflow and displacement of anatomical targets. The review of the literature showed that conserving a physiological intra-extracranial pressure gradient plays a fundamental role in avoiding pneumocephalus and consequent displacement of brain structures, which improves surgical accuracy and DBS long-term results.
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Affiliation(s)
- Giacomo Beggio
- Department of Neurosurgery, San Bortolo Hospital AULSS 8 Berica, Viale Rodolfi, 37 36100, Vicenza, VI, Italy.
| | - Fabio Raneri
- Department of Neurosurgery, San Bortolo Hospital AULSS 8 Berica, Viale Rodolfi, 37 36100, Vicenza, VI, Italy
| | - Oriela Rustemi
- Department of Neurosurgery, San Bortolo Hospital AULSS 8 Berica, Viale Rodolfi, 37 36100, Vicenza, VI, Italy
| | - Alba Scerrati
- Department of Neurosurgery, San Bortolo Hospital AULSS 8 Berica, Viale Rodolfi, 37 36100, Vicenza, VI, Italy
| | - Giampaolo Zambon
- Department of Neurosurgery, San Bortolo Hospital AULSS 8 Berica, Viale Rodolfi, 37 36100, Vicenza, VI, Italy
| | - Massimo Piacentino
- Department of Neurosurgery, San Bortolo Hospital AULSS 8 Berica, Viale Rodolfi, 37 36100, Vicenza, VI, Italy
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Ponce FA. Intraoperative Magnetic Resonance Imaging and Computed Tomography. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wang J, Ponce FA, Tao J, Yu HM, Liu JY, Wang YJ, Luan GM, Ou SW. Comparison of Awake and Asleep Deep Brain Stimulation for Parkinson's Disease: A Detailed Analysis Through Literature Review. Neuromodulation 2019; 23:444-450. [PMID: 31830772 DOI: 10.1111/ner.13061] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/22/2019] [Accepted: 09/11/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Deep brain stimulation (DBS) for Parkinson's disease (PD) has been applied to clinic for approximately 30 years. The goal of this review is to explore the similarities and differences between "awake" and "asleep" DBS techniques. METHODS A comprehensive literature review was carried out to identify relevant studies and review articles describing applications of "awake" or "asleep" DBS for Parkinson's disease. The surgical procedures, clinical outcomes, costs and complications of each technique were compared in detail through literature review. RESULTS The surgical procedures of awake and asleep DBS surgeries rely upon different methods for verification of intended target acquisition. The existing research results demonstrated that the stereotactic targeting accuracy of lead placement obtained by either method is reliable. There were no significant differences in clinical outcomes, costs, or complications between the two techniques. CONCLUSION The surgical and clinical outcomes of asleep DBS for PD are comparable to those of awake DBS.
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Affiliation(s)
- Jun Wang
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, P. R., China
| | - Francisco A Ponce
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jun Tao
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, P. R., China
| | - Hong-Mei Yu
- Department of Neurology, The First Hospital of China Medical University, Shenyang, P. R., China
| | - Ji-Yuan Liu
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, P. R., China
| | - Yun-Jie Wang
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, P. R., China
| | - Guo-Ming Luan
- Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, P. R., China
| | - Shao-Wu Ou
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, P. R., China
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Carron R. Commentary: Intraoperative High Impedance Levels During Placement of Deep Brain Stimulating Electrode. Oper Neurosurg (Hagerstown) 2019; 17:E267-E268. [PMID: 31214717 DOI: 10.1093/ons/opz158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 03/24/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Romain Carron
- Aix Marseille Université, INSERM, INS, Institut de Neurosciences des Systèmes, Marseille, France.,Department of Functional and Stereotactic Neurosurgery, Timone University Hospital, Marseille, France
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29
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Kremer NI, Oterdoom DLM, van Laar PJ, Piña-Fuentes D, van Laar T, Drost G, van Hulzen ALJ, van Dijk JMC. Accuracy of Intraoperative Computed Tomography in Deep Brain Stimulation-A Prospective Noninferiority Study. Neuromodulation 2019; 22:472-477. [PMID: 30629330 PMCID: PMC6618091 DOI: 10.1111/ner.12918] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/04/2018] [Accepted: 11/30/2018] [Indexed: 01/09/2023]
Abstract
Introduction Clinical response to deep brain stimulation (DBS) strongly depends on the appropriate placement of the electrode in the targeted structure. Postoperative MRI is recognized as the gold standard to verify the DBS‐electrode position in relation to the intended anatomical target. However, intraoperative computed tomography (iCT) might be a feasible alternative to MRI. Materials and Methods In this prospective noninferiority study, we compared iCT with postoperative MRI (24‐72 hours after surgery) in 29 consecutive patients undergoing placement of 58 DBS electrodes. The primary outcome was defined as the difference in Euclidean distance between lead tip coordinates as determined on both imaging modalities, using the lead tip depicted on MRI as reference. Secondary outcomes were difference in radial error and depth, as well as difference in accuracy relative to target. Results The mean difference between the lead tips was 0.98 ± 0.49 mm (0.97 ± 0.47 mm for the left‐sided electrodes and 1.00 ± 0.53 mm for the right‐sided electrodes). The upper confidence interval (95% CI, 0.851 to 1.112) did not exceed the noninferiority margin established. The average radial error between lead tips was 0.74 ± 0.48 mm and the average depth error was determined to be 0.53 ± 0.40 mm. The linear Deming regression indicated a good agreement between both imaging modalities regarding accuracy relative to target. Conclusions Intraoperative CT is noninferior to MRI for the verification of the DBS‐electrode position. CT and MRI have their specific benefits, but both should be considered equally suitable for assessing accuracy.
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Affiliation(s)
- Naomi I Kremer
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - D L Marinus Oterdoom
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter Jan van Laar
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dan Piña-Fuentes
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gea Drost
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arjen L J van Hulzen
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Marc C van Dijk
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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