Department of Surgical Intensive Care, Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore.
SingHealth Duke-NUS Anaesthesiology and Perioperative Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore.
Stereotact Funct Neurosurg. 2024;102(3):141-155. doi: 10.1159/000536310. Epub 2024 Apr 18.
Deep brain stimulation (DBS) is a well-established surgical therapy for patients with Parkinsons' Disease (PD). Traditionally, DBS surgery for PD is performed under local anesthesia, whereby the patient is awake to facilitate intraoperative neurophysiological confirmation of the intended target using microelectrode recordings. General anesthesia allows for improved patient comfort without sacrificing anatomic precision and clinical outcomes.
We performed a systemic review and meta-analysis on patients undergoing DBS for PD. Published randomized controlled trials, prospective and retrospective studies, and case series which compared asleep and awake techniques for patients undergoing DBS for PD were included. A total of 19 studies and 1,900 patients were included in the analysis.
We analyzed the (i) clinical effectiveness - postoperative UPDRS III score, levodopa equivalent daily doses and DBS stimulation requirements. (ii) Surgical and anesthesia related complications, number of lead insertions and operative time (iii) patient's quality of life, mood and cognitive measures using PDQ-39, MDRS, and MMSE scores. There was no significant difference in results between the awake and asleep groups, other than for operative time, for which there was significant heterogeneity.
With the advent of newer technology, there is likely to have narrowing differences in outcomes between awake or asleep DBS. What would therefore be more important would be to consider the patient's comfort and clinical status as well as the operative team's familiarity with the procedure to ensure seamless transition and care.
脑深部电刺激（DBS）是一种治疗帕金森病（PD）的成熟手术疗法。传统上，PD 的 DBS 手术是在局部麻醉下进行的，患者在手术过程中保持清醒，以便使用微电极记录来确认目标。全身麻醉可以提高患者的舒适度，而不会牺牲解剖精度和临床结果。
我们对接受 DBS 治疗 PD 的患者进行了系统回顾和荟萃分析。纳入了比较 PD 患者接受 DBS 时入睡和清醒技术的随机对照试验、前瞻性和回顾性研究以及病例系列研究。共纳入 19 项研究和 1900 例患者进行分析。
我们分析了（i）临床效果 - 术后 UPDRS III 评分、左旋多巴等效日剂量和 DBS 刺激需求。（ii）手术和麻醉相关并发症、导丝插入数量和手术时间。（iii）使用 PDQ-39、MDRS 和 MMSE 评分评估患者的生活质量、情绪和认知。除了手术时间之外，清醒组和入睡组的结果没有显著差异，而手术时间存在显著的异质性。
随着新技术的出现，清醒或入睡 DBS 之间的结果差异可能会缩小。因此，更重要的可能是考虑患者的舒适度和临床状况，以及手术团队对手术的熟悉程度，以确保顺利过渡和护理。
