Subthalamic deep brain stimulation after anesthetic inhalation in Parkinson disease: a preliminary study

Sheng-Huang Lin, M.D., M.Sc.1, Tsung-Ying Chen, M.D.2, Shinn-Zong Lin, M.D., Ph.D.3, Ming-Hwang Shyr, M.D., Ph.D.2, Yu-Cheng Chou, M.D.3, Wanhua Annie Hsieh, Ph.D.4, Sheng-Tzung Tsai, M.D.3, and Shin-Yuan Chen, M.D., M.Sc.3

1Departments of Neurology, 2Anesthesiology, and 3Neurosurgery, Tzu Chi General Hospital, Tzu Chi University; and 4Institute of Aboriginal Health, Tzu Chi University, Hualien, Taiwan

Abbreviations used in this paper: DBS = deep brain stimulation; MAC = minimal alveolar concentration; MER = microelectrode recording; PD = Parkinson disease; SD = standard deviation; SNr = substantia pars nigra reticulata; STN = subthalamic nucleus; UPDRS = Unified Parkinson's Disease Rating Scale.

Object

The authors of this preliminary study investigated the outcome and feasibility of intraoperative microelectrode recording (MER) in patients with Parkinson disease (PD) undergoing deep brain stimulation of the subthalamic nucleus (STN) after anesthetic inhalation.

Methods

The authors conducted a retrospective analysis of 10 patients with PD who received a desflurane anesthetic during bilateral STN electrode implantation. The MERs were obtained as an intraoperative guide for final electrode implantation and the data were analyzed offline. The functional target coordinates of the electrodes were compared preoperatively with estimated target coordinates.

Results

Outcomes were evaluated using the Unified Parkinson's Disease Rating Scale 6 months after surgery. The mean improvement in total and motor Unified Parkinson's Disease Rating Scale scores was 54.27 ± 17.96% and 48.85 ± 16.97%, respectively. The mean STN neuronal firing rate was 29.7 ± 14.6 Hz. Typical neuronal firing patterns of the STN and substantia pars nigra reticulata were observed in each patient during surgery. Comparing the functional target coordinates, the z axis coordinates were noted to be significantly different between the pre- and postoperative coordinates.

Conclusions

The authors found that MER can be adequately performed while the patient receives a desflurane anesthetic, and the results can serve as a guide for STN electrode implantation. This may be a good alternative surgical method in patients with PD who are unable to tolerate deep brain stimulation surgery with local anesthesia.

Archives of Neurology

Vol. 65 N. 8 Aug. 2008