Lu Yue, Chang Lei, Li Jinwen, Luo Bei, Dong Wenwen, Qiu Chang, Zhang Wenbin, Ruan Yifeng
Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
Department of Anesthesiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
Front Neurosci. 2022 May 26;16:917752. doi: 10.3389/fnins.2022.917752. eCollection 2022.
Subthalamic nucleus deep brain stimulation (STN-DBS) surgery for Parkinson's disease (PD) is routinely performed at medical centers worldwide. However, it is debated whether general anesthesia (GA) or traditional local anesthetic (LA) is superior.
This study aims to compare the effects of LA and GA operation methods on clinical improvement in patients with PD, such as motor and non-motor symptoms, after STN-DBS surgery at our center.
A total of 157 patients with PD were retrospectively identified as having undergone surgery under LA ( = 81) or GA ( = 76) states. In this study, the Unified Parkinson's Disease Rating Scale Motor Score (UPDRS-III) in three states, levodopa-equivalent-daily-dose (LEDD), surgical duration, intraoperative microelectrode recording (iMER) signal length, postoperative intracranial volume, electrode implantation error, neuropsychological function, quality of life scores, and complication rates were collected and compared. All patients with PD were routinely followed up at 6, 12, 18, and 24 months postoperatively.
Overall improvement in UPDRS-III was demonstrated at postoperative follow-up, and there was no significant difference between the two groups in medication-off, stimulation-off state and medication-off, stimulation-on state. However, UPDRS-III scores in medication-on, stimulation-on state under GA was significantly lower than that in the LA group. During postoperative follow-up, LEDD in the LA group (6, 12, 18, and 24 months, postoperatively) was significantly lower than in the GA group. However, there were no significant differences at baseline or 1-month between the two groups. The GA group had a shorter surgical duration, lower intracranial volume, and longer iMER signal length than the LA group. However, there was no significant group difference in electrode implantation accuracy and complication rates. Additionally, the Hamilton Anxiety Scale (HAMA) was significantly lower in the GA group than the LA group at 1-month follow-up, but this difference disappeared at longer follow-up. Besides, there was no significant group difference in the 39-item Parkinson's Disease Questionnaire (PDQ-39) scale scores.
Although both groups showed overall motor function improvement without a significant postoperative difference, the GA group seemed superior in surgical duration, intracranial volume, and iMER signal length. As the accuracy of electrode implantation can be ensured by iMER monitoring, DBS with GA will become more widely accepted.
全球各医疗中心均常规开展针对帕金森病（PD）的丘脑底核深部脑刺激（STN-DBS）手术。然而，全身麻醉（GA）与传统局部麻醉（LA）哪种更具优势仍存在争议。
本研究旨在比较在我们中心，LA和GA手术方式对PD患者行STN-DBS手术后临床改善情况的影响，如运动和非运动症状。
回顾性纳入157例行LA（n = 81）或GA（n = 76）状态下手术的PD患者。本研究收集并比较了三种状态下的统一帕金森病评定量表运动评分（UPDRS-III）、左旋多巴等效日剂量（LEDD）、手术时长、术中微电极记录（iMER）信号长度、术后颅内容积、电极植入误差、神经心理功能、生活质量评分及并发症发生率。所有PD患者术后均于6、12、18和24个月进行常规随访。
术后随访显示UPDRS-III总体改善，两组在关药、关刺激状态及关药、开刺激状态下无显著差异。然而，GA状态下开药、开刺激状态时的UPDRS-III评分显著低于LA组。术后随访期间，LA组术后6、12、18和24个月的LEDD显著低于GA组。但两组在基线或1个月时无显著差异。GA组手术时长更短、颅内容积更小、iMER信号长度更长。然而，两组在电极植入准确性和并发症发生率方面无显著差异。此外，GA组在1个月随访时汉密尔顿焦虑量表（HAMA）显著低于LA组，但在更长随访期该差异消失。此外，两组在39项帕金森病问卷（PDQ-39）量表评分上无显著差异。
尽管两组均显示出总体运动功能改善且术后无显著差异，但GA组在手术时长、颅内容积和iMER信号长度方面似乎更具优势。由于iMER监测可确保电极植入准确性，GA下的DBS将被更广泛接受。
