Qian Kang, Wang Jiajing, Rao Jing, Zhang Peng, Sun Yaqiang, Hu Wenqing, Hao Jie, Jiang Xiaobing, Fu Peng
Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Wuhan National Laboratory for Optoelectronics, Britton Chance Center for Biomedical Photonics, Huazhong University of Science and Technology, Wuhan, China.
Front Neurol. 2023 Feb 23;14:1117681. doi: 10.3389/fneur.2023.1117681. eCollection 2023.
Microelectrode recording (MER) guided subthalamic nucleus deep brain stimulation (STN-DBS) under local anesthesia (LA) is widely applied in the management of advanced Parkinson's disease (PD). Whereas, awake DBS under LA is painful and burdensome for PD patients. We analyzed the influence of general anesthesia (GA) on intraoperative MER, to assess the feasibility and effectiveness of GA in MER guided STN-DBS.
Retrospective analysis was performed on the PD patients, who underwent bilateral MER guided STN-DBS in Wuhan Union Hospital from July 2019 to December 2021. The patients were assigned to LA or GA group according to the anesthetic methods implemented. Multidimensional parameters, including MER signals, electrode implantation accuracy, clinical outcome and adverse events, were analyzed.
A total of 40 PD patients were enrolled in this study, including 18 in LA group and 22 in GA group. There were no statistically significant differences in patient demographics and baseline characteristics between two groups. Although, the parameters of MER signal, including frequency, inter-spike interval (ISI) and amplitude, were obviously interfered under GA, the waveforms of MER signals were recognizable and shared similar characteristics with LA group. Both LA and GA could achieve effective electrode implantation accuracy and clinical outcome. They also shared similar adverse events postoperatively.
GA is viable and comparable to LA in MER guided STN-DBS for PD, regarding electrode implantation accuracy, clinical outcome and adverse events. Notably, GA is more friendly and acceptable to the patients who are incapable of enduring intraoperative MER under LA.
微电极记录（MER）引导下的局部麻醉（LA）丘脑底核脑深部电刺激（STN-DBS）广泛应用于晚期帕金森病（PD）的治疗。然而，LA下的清醒DBS对PD患者来说既痛苦又负担沉重。我们分析了全身麻醉（GA）对术中MER的影响，以评估GA在MER引导的STN-DBS中的可行性和有效性。
对2019年7月至2021年12月在武汉协和医院接受双侧MER引导的STN-DBS的PD患者进行回顾性分析。根据实施的麻醉方法将患者分为LA组或GA组。分析了包括MER信号、电极植入准确性、临床结果和不良事件在内的多维参数。
本研究共纳入40例PD患者，其中LA组18例，GA组22例。两组患者的人口统计学和基线特征无统计学显著差异。虽然，GA下MER信号的参数，包括频率、峰间期（ISI）和幅度，受到明显干扰，但MER信号的波形是可识别的，并且与LA组具有相似的特征。LA和GA均可实现有效的电极植入准确性和临床结果。它们术后的不良事件也相似。
在电极植入准确性、临床结果和不良事件方面，GA在MER引导的PD患者STN-DBS中是可行的，且与LA相当。值得注意的是，GA对那些无法忍受LA下术中MER的患者来说更友好且更容易接受。
