State University of Piauí (UESPI), Campus Poeta Torquato Neto - João Cabral St., Pirajá, Teresina, Piauí, Piauí, 64002-150, Brazil.
Federal University of Piauí (UFPI), Teresina, Brazil.
Neurosurg Rev. 2024 Jul 24;47(1):346. doi: 10.1007/s10143-024-02611-w.
Deep brain stimulation (DBS) stands as the preferred treatment for Parkinson's disease (PD) patients manifesting refractory motor symptoms or when medication side effects outweigh the benefits. Though traditionally administered under local anesthesia coupled with sedation (LA + S), recent evidence hints at comparable outcomes under general anesthesia (GA). This systematic review and meta-analysis aimed to scrutinize post-surgical outcomes in randomized PD patients undergoing DBS surgery while GA versus LA + S. We searched PubMed, Cochrane, and Embase databases following PRISMA guidelines. We included randomized studies directly comparing DBS surgery under GA versus LA + S, delineating clinical outcomes. Safety outcomes assessed disparities in infection and hemorrhage risk. Mean differences (MD) and Risk Differences (RD) with 95% Confidence Intervals (CI) were utilized to evaluate outcomes, under a random-effects model. Heterogeneity was evaluated through I² statistics, and in studies exhibiting high heterogeneity, exclusion analysis was performed. Evaluated outcomes encompassed motor improvement, complications, behavioral and mood effects gauged by the Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Questionnaire 39 (PDQ39), and daily levodopa equivalent dose (LEDD). A total of 3 studies, encompassing 203 patients, were reviewed. At a 6-month follow-up, in patients undergoing GA during surgery, there was no statistically significant difference compared to the LA + S group in terms of UPDRS III ON (MD 0.19; 95% CI -2.21 to 2.59; p = 0.88; I²=0%), UPDRS III OFF (MD 0.58; 95% CI -4.30 to 5.45; p = 0.21; I²=0%), UPDRS IV ON ( (MD 0.98; 95% CI -0.95 to 2.92; p = 0.32; I²=23%), PDQ39 (MD -1.27; 95% CI -6.31 to 3.77; p = 0.62; I²=0%), and LEDD (MD -1.99; 95% CI -77.88 to 73.90; p = 0.96; I²=32%). There was no statistically significant difference between groups in terms of infection (RD 0.02; 95% CI -0.02 to 0.05; p = 0.377; I²=0%) or hemorrhage (RD 0.04; 95% CI -0.03 to 0.11; p = 0.215; I²=0%). Our findings suggest, based on short-term follow-up, that GA is not inferior to LA + S in terms of benefits for the selected outcomes. However, further studies are needed to determine whether there are significant long-term clinical differences between these groups.
脑深部刺激 (DBS) 是治疗帕金森病 (PD) 患者出现难治性运动症状或药物副作用超过益处的首选方法。虽然传统上在局部麻醉加镇静 (LA+S) 下进行，但最近的证据表明全身麻醉 (GA) 下也有类似的效果。本系统评价和荟萃分析旨在研究 GA 与 LA+S 下接受 DBS 手术的随机 PD 患者的术后结果。我们按照 PRISMA 指南搜索了 PubMed、Cochrane 和 Embase 数据库。我们纳入了直接比较 GA 与 LA+S 下 DBS 手术的随机研究，描述了临床结果。安全性结果评估了感染和出血风险的差异。使用 95%置信区间 (CI) 的均数差 (MD) 和风险差 (RD) 来评估结果，采用随机效应模型。通过 I²统计评估异质性，并对显示高度异质性的研究进行排除分析。评估的结果包括运动改善、并发症、使用统一帕金森病评定量表 (UPDRS)、帕金森病问卷 39 (PDQ39) 和每日左旋多巴等效剂量 (LEDD) 测量的行为和情绪影响。共审查了 3 项研究，共 203 名患者。在 6 个月的随访中，与 LA+S 组相比，在手术中接受 GA 的患者在 UPDRS III ON 方面没有统计学上的显著差异（MD 0.19；95%CI-2.21 至 2.59；p=0.88；I²=0%），UPDRS III OFF（MD 0.58；95%CI-4.30 至 5.45；p=0.21；I²=0%），UPDRS IV ON（MD 0.98；95%CI-0.95 至 2.92；p=0.32；I²=23%），PDQ39（MD-1.27；95%CI-6.31 至 3.77；p=0.62；I²=0%）和 LEDD（MD-1.99；95%CI-77.88 至 73.90；p=0.96；I²=32%）。两组在感染（RD 0.02；95%CI-0.02 至 0.05；p=0.377；I²=0%）或出血（RD 0.04；95%CI-0.03 至 0.11；p=0.215；I²=0%）方面无统计学显著差异。我们的研究结果表明，基于短期随访，GA 在所选结果方面并不逊于 LA+S。然而，需要进一步的研究来确定这两组之间是否存在显著的长期临床差异。
