Subthalamic deep brain stimulation after anesthetic inhalation in Parkinson disease: a preliminary study.
OBJECTIVE
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.
Lin
Sheng-Huang
SH
Department of Neurology, Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan.
Chen
Tsung-Ying
TY
Lin
Shinn-Zong
SZ
Shyr
Ming-Hwang
MH
Chou
Yu-Cheng
YC
Hsieh
Wanhua Annie
WA
Tsai
Sheng-Tzung
ST
Chen
Shin-Yuan
SY
D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage; D046690:Deep Brain Stimulation; D000077335:Desflurane; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008297:Male; D008839:Microelectrodes; D008875:Middle Aged; D010300:Parkinson Disease / Q000628:therapy*; D010865:Pilot Projects; D012189:Retrospective Studies; D020531:Subthalamic Nucleus / Q000502:physiology*; D016896:Treatment Outcome
D018685:Anesthetics, Inhalation; D000779:Anesthetics, Local; D000077335:Desflurane; D007530:Isoflurane