A comparative study of asleep and awake deep brain stimulation robot-assisted surgery for Parkinson's disease

Abstract

To compare the differences between asleep and awake robot-assisted deep brain stimulation (DBS) surgery for Parkinson's Disease (PD), we conducted this retrospective cohort study included 153 PD patients undergoing bilateral robot-assisted DBS from June 2017 to August 2019, of which 58 cases were performed under general anesthesia (GA) and 95 cases under local anesthesia (LA). Procedure duration, stimulation parameters, electrode implantation accuracy, intracranial air, intraoperative electrophysiological signal length, complications, and Unified PD Rating Scale (UPDRS) measurements were recorded and compared. The clinical evaluation was conducted by two raters who were blinded to the choice of anesthesia. Procedure duration was significantly shorter in the GA group, while on stimulation off medication motor scores (UPDRS-III) were significantly improved in both the GA and LA group. ANCOVA covariated for the baseline UPDRS-III and levodopa challenge exhibited no significant differences. In terms of amplitude, frequency, and pulse width, the stimulation parameters used for DBS power-on were similar. There were no significant differences in electrode implantation accuracy, intraoperative electrophysiological signal length, or intracerebral hemorrhage (no occurrences in either group). The pneumocephalus volume was significantly smaller in the GA group. Six patients exhibited transient throat discomfort associated with tracheal intubation in the GA group. The occurrence of surgical incision infection was similar in both groups. Compared with the awake group, the asleep group exhibited a shorter procedure duration with a similar electrode implantation accuracy and short-term motor improvement. Robot-assisted asleep DBS surgery is a promising surgical method for PD.

Keywords: Parkinson's disease.

Fig. 1. Preoperative planning.

a DBS surgical planning in ROSA Robot system. b target shown in MRI T2 image. c Trajectory planning relying on MRI image. d Trajectory planning relying on contrast-enhanced CT image to avoid damage to cerebral vessels.

Fig. 2. Registration and verification.

(There was consent to use the photographs). a Preoperative registration (the first registration) of markers fixed on the skull. b After skin incision and skull hole drilling, intraoperative registration (the second registration) of markers. c, d Intraoperative verification of simulated target before electrode implantation.

Fig. 3. Asleep compared with awake DBS surgery.

a Procedure duration was significantly shorter in the GA group (GA 1.09 ± 0.46 h vs. LA 1.54 ± 0.57 h, p < 0.0001). b Tao’s DBS surgery scale were significantly higher in the GA group (GA 85.2 ± 9.3 vs. LA 76.5 ± 8.0, p < 0.0001).