Awake Versus Asleep Deep Brain Stimulation Surgery: Technical Considerations and Critical Review of the Literature

Overview

Journal Brain Sci

Publisher MDPI

Date 2018 Jan 20

PMID 29351243

Citations 17

Authors

Ryan B Kochanski

Sepehr Sani

Affiliations

Soon will be listed here.

Abstract

Advancements in neuroimaging have led to a trend toward direct, image-based targeting under general anesthesia without the use of microelectrode recording (MER) or intraoperative test stimulation, also referred to as "asleep" deep brain stimulation (DBS) surgery. Asleep DBS, utilizing imaging in the form of intraoperative computed tomography (iCT) or magnetic resonance imaging (iMRI), has demonstrated reliable targeting accuracy of DBS leads implanted within the globus pallidus and subthalamic nucleus while also improving clinical outcomes in patients with Parkinson's disease. In lieu, of randomized control trials, retrospective comparisons between asleep and awake DBS with MER have shown similar short-term efficacy with the potential for decreased complications in asleep cohorts. In lieu of long-term outcome data, awake DBS using MER must demonstrate more durable outcomes with fewer stimulation-induced side effects and lead revisions in order for its use to remain justifiable; although patient-specific factors may also be used to guide the decision regarding which technique may be most appropriate and tolerable to the patient.

Citing Articles

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Prediction of pyramidal tract side effect threshold by intra-operative electromyography in subthalamic nucleus deep brain stimulation for patients with Parkinson's disease under general anaesthesia.

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