Journal of the Korean Society of Stereotactic and Functional Neurosurgery 2020;16(1):6-12.
Published online June 30, 2020.
Subthalamic Deep Brain Stimulation Under General Anesthesia for Advanced Parkinson's Disease
Kwang Hyon Park, Sun Ha Paek
Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, Korea, Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea, Ischemia Hypoxia Disease Institute, Seoul National University College of Medicine, Seoul, Korea, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
The deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment to improve motor function in patients with advanced Parkinson's disease. In various centers, this treatment is performed on patients under local anesthesia and general anesthesia with or without microelectrode recording (MER). Recently, no significant differences in Unified Parkinson's Disease Rating Scale III score, levodopa equivalent daily dose, stimulation parameters, coordination of targeting, and STN recording length of the asleep and awake cohorts are found. Moreover, the anesthetic effects on MER depends on the agents used. Despite the change in firing rate and pattern, no obstacles with targeting and no significant effects on clinical outcomes were found. The development of imaging modalities and devices also plays a role in the advance of DBS. Intraoperative CT and MRI are widely used to evaluate electrode position intraoperatively. Using intraoperative imaging under general anesthesia without MER, the error was similar to that with MER. Currently more studies are conducted to improve the effectiveness of DBS and reduce its side effects.
Key Words: Deep brain stimulation, Subthalamic nucleus, Parkinson's disease, General anesthesia, Microelectrode recording, Intraoperative imaging.

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