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. 2024 Jul 20;47(1):342.
doi: 10.1007/s10143-024-02563-1.

Intraoperative microelectrode recording during asleep deep brain stimulation of subthalamic nucleus for Parkinson Disease. A case series with systematic review of the literature

Alessandro Izzo #  1 , Carla Piano #  2   3 , Manuela D'Ercole  1 , Quintino Giorgio D'Alessandris  4   5 , Tommaso Tufo  1 , Maria Filomena Fuggetta  1 , Federica Figà  1   2 , Renata Martinelli  1   2 , Marco Obersnel  1   2 , Francesco Pambianco  2 , Francesco Bove  3 , Valerio Perotti  2   6 , Anna Rita Bentivoglio  2   3 , Alessandro Olivi  1   2 , Nicola Montano  1   2
Affiliations

Intraoperative microelectrode recording during asleep deep brain stimulation of subthalamic nucleus for Parkinson Disease. A case series with systematic review of the literature

Alessandro Izzo et al. Neurosurg Rev. .

Abstract

The use of microelectrode recording (MER) during deep brain stimulation (DBS) for Parkinson Disease is controversial. Furthermore, in asleep DBS anesthesia can impair the ability to record single-cell electric activity.The purpose of this study was to describe our surgical and anesthesiologic protocol for MER assessment during asleep subthalamic nucleus (STN) DBS and to put our findings in the context of a systematic review of the literature. Sixty-three STN electrodes were implanted in 32 patients under general anesthesia. A frameless technique using O-Arm scanning was adopted in all cases. Total intravenous anesthesia, monitored with bispectral index, was administered using a target controlled infusion of both propofol and remifentanil. A systematic review of the literature with metanalysis on MER in asleep vs awake STN DBS for Parkinson Disease was performed. In our series, MER could be reliably recorded in all cases, impacting profoundly on electrode positioning: the final position was located within 2 mm from the planned target only in 42.9% cases. Depth modification > 2 mm was necessary in 21 cases (33.3%), while in 15 cases (23.8%) a different track was used. At 1-year follow-up we observed a significant reduction in LEDD, UPDRS Part III score off-medications, and UPDRS Part III score on medications, as compared to baseline. The systematic review of the literature yielded 23 papers; adding the cases here reported, overall 1258 asleep DBS cases using MER are described. This technique was safe and effective: metanalysis showed similar, if not better, outcome of asleep vs awake patients operated using MER. MER are a useful and reliable tool during asleep STN DBS, leading to a fine tuning of electrode position in the majority of cases. Collaboration between neurosurgeon, neurophysiologist and neuroanesthesiologist is crucial, since slight modifications of sedation level can impact profoundly on MER reliability.

Keywords: Asleep; Deep brain stimulation; Microelectrode recording; Parkinson disease.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
MER showing the typical STN discharge pattern in 2 PD patients operated under general anesthesia. Implanted depth, 0 (upper patient), + 2 mm (lower patient)
Fig. 2
Fig. 2
The PRISMA 2020 flow diagram
Fig. 3
Fig. 3
Forest plots (left column) and funnel plots (right column) regarding, from top to bottom, number of MER tracks per patient, reduction in UPDRS Part III score off and on medication, LEDD reduction and surgical morbidity. In each forest plot, right favors asleep DBS and left favors awake DBS
See this image and copyright information in PMC

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