Sensorimotor Physiological Mapping During Asleep Deep Brain Stimulation Lead Placement With Multichannel Intraoperative Neuromonitoring.

BACKGROUND AND OBJECTIVES

Lead placement during asleep deep brain stimulation (DBS) surgery has relied primarily on intraoperative imaging, forgoing traditional awake neurophysiological testing. We aimed to describe our experience of asleep macrostimulation mapping of implanted DBS leads using intraoperative neuromonitoring (IONM) techniques, which were used to guide electrode placement-in addition to intraoperative computed tomography imaging and in place of awake neurophysiological testing.

METHODS

This was a single institution retrospective study of asleep DBS surgery with IONM mapping for Parkinson's disease, ET, and dystonia targeting the ventral intermediate nucleus, subthalamic nucleus, and globus pallidus interna.

RESULTS

A series of 88 consecutive patients from a single surgeon were included. 67 patients received DBS for Parkinson's disease, 14 for essential tremor, and 7 for dystonia. The DBS target was globus pallidus interna for 60 patients, subthalamic nucleus for 14, and ventral intermediate nucleus for 14, with 95.5% undergoing bilateral lead placement. The mean single stage surgery time was 170 minutes. No patients required surgical lead revision, and no unanticipated sensorimotor side effects were noted during DBS programming. Compared with patients undergoing awake DBS surgery, there was no significant difference in patient-reported outcomes.

CONCLUSION

Asleep IONM mapping offers valuable physiological data to guide electrode asleep DBS placement and complement intraoperative imaging techniques.