Analysis of electrophysiological results of subthalamic nucleus in deep brain stimulation under local or general anesthesia for Parkinson's disease

Abstract

Objective To compare the electrophysiological results of subthalamic nucleus deep brain stimulation (STN⁃DBS) for the treatment of Parkinson's disease (PD) under local or general anesthesia. Methods The data of 44 patients with PD who underwent STN⁃DBS surgery were retrospectively analyzed from January 2017 to October 2019. Among them, 22 cases were performed under general anesthesia with bispectral index (BIS), and the other 22 were implanted under local anesthesia. Microelectrode recording (MER) was used in 2 groups to locate the STN during operation and the electrophysiological signal length and the radial error of the electrode target after the MRI or CT reexaimined were analyzed and compared between 2 groups. Results Both general anesthesia group and local anesthesia group recorded typical discharges of the STN and located its sensorimotor function sub⁃regions. When the BIS value of patients in general anesthesia group was adjusted to 70 or above, their STN electrophysiological conditions were consistent with those under local anesthesia. There was no statistically significant difference in the electrophysiological length of bilateral STN between general anesthesia group and local anesthesia group [left (5.46 ± 0.98) mm vs. (5.30 ± 0.91) mm; t = 0.561, P = 0.578; right (5.21 ± 0.85) mm vs. (5.21 ± 1.21) mm; t = 0.000, P = 1.000]. There was no statistically significant difference in Unified Parkinson's Disease Rating Scale⁃Ⅲ (UPDRS⁃Ⅲ) score (16.37 ± 0.83 vs. 16.20 ± 0.98; t = 0.621, P = 0.538) and incidence of adverse reactions [68.18% (15/22) vs. 72.73% (16/22); χ² = 0.109, P = 0.741] between 2 groups. After reexamination of MRI or CT and fusion with intraoperative MRI, there was no statistically significant difference in the radial error of the bilateral electrode targets between 2 groups [left (1.24 ± 0.56) mm vs. (1.18 ± 0.52) mm; t = 0.337, P = 0.738; right (1.10 ± 0.45) mm vs. (1.05 ± 0.53) mm, t = 0.368, P = 0.715]. Conclusions The typical discharge of STN could be recorded in both local and general anesthesia STN⁃DBS groups, and the sensory ⁃ motor area of STN could also be accurately indentified through its discharge. There is no significant difference in the length of STN electrophysiological signal and electrode error between 2 groups. The results showed that the precise implantation of intracranial electrodes in STN⁃DBS surgery could be performed under local or general anesthesia.

DOI：10.3969/j.issn.1672⁃6731.2020.12.005