Tsai Sheng-Tzung, Chen Tsung-Ying, Lin Sheng-Huang, Chen Shin-Yuan
Department of Neurosurgery, Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan.
Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
Parkinsons Dis. 2019 Jan 17;2019:5676345. doi: 10.1155/2019/5676345. eCollection 2019.
Studies comparing long-term outcomes between general anesthesia (GA) and local anesthesia (LA) for STN-DBS in Parkinson's disease (PD) are lacking. Whether patients who received STN-DBS in GA could get the same benefit without compromising electrophysiological recording is debated.
We compared five-year outcomes for different anesthetic methods (GA vs LA) during STN-DBS for PD. Thirty-six consecutive PD patients with similar preoperative characteristics, including age, disease duration, and severity, underwent the same surgical procedures except the GA (=22) group with inhalational anesthesia and LA (=14) with local anesthesia during microelectrode recording and intraoperative macrostimulation test. Surgical outcome evaluations included Unified Parkinson's Disease Rating Scale (UPDRS), Mini-Mental Status Examinations, and the Beck Depression Inventory. Stimulation parameters and coordinates of STN targeting were also collected.
Both groups attained similar benefits in UPDRS part III from STN-DBS (GA 43.2 ± 14.1% vs. LA 46.8 ± 13.8% decrease, =0.45; DBS on/Med off vs. DBS off/Med off) and no difference in reduction of levodopa equivalent doses (GA 47.56 ± 18.98% vs. LA 51.37 ± 31.73%, =0.51) at the five-year follow-up. In terms of amplitude, frequency, and pulse width, the stimulation parameters used for DBS were comparable, and the coordinates of preoperative targeting and postoperative electrode tip were similar between two groups. There was no difference in STN recording length as well. Significantly less number of MER tracts in GA was found (=0.04). Adverse effects were similar in both groups.
Our study confirmed that STN localization with microelectrode recording and patient comfort could be achieved based on equal effectiveness and safety of STN-DBS under GA compared with LA.
缺乏关于帕金森病（PD）患者接受丘脑底核深部脑刺激（STN-DBS）时全身麻醉（GA）与局部麻醉（LA）长期疗效比较的研究。接受GA下STN-DBS的患者在不影响电生理记录的情况下是否能获得相同益处存在争议。
我们比较了PD患者接受STN-DBS时不同麻醉方法（GA与LA）的五年疗效。36例术前特征（包括年龄、病程和严重程度）相似的连续PD患者接受了相同的手术操作，其中22例GA组采用吸入麻醉，14例LA组在微电极记录和术中宏观刺激测试期间采用局部麻醉。手术疗效评估包括统一帕金森病评定量表（UPDRS）、简易精神状态检查和贝克抑郁量表。还收集了刺激参数和STN靶点坐标。
两组在STN-DBS术后UPDRS第三部分均获得相似益处（GA组下降43.2±14.1%，LA组下降46.8±13.8%，P=0.45；刺激开启/药物关闭与刺激关闭/药物关闭），五年随访时左旋多巴等效剂量减少无差异（GA组47.56±18.98%，LA组51.37±31.73%，P=0.51）。在幅度、频率和脉宽方面，用于DBS的刺激参数具有可比性，两组术前靶点坐标和术后电极尖端坐标相似。STN记录长度也无差异。GA组的微电极记录轨迹数量明显更少（P=0.04）。两组不良反应相似。
我们的研究证实，与LA相比，GA下STN-DBS在有效性和安全性相同的基础上，可实现基于微电极记录的STN定位和患者舒适度。
