Introduction: Given recent advancements in stereotactic techniques and intraoperative imaging for deep brain stimulation (DBS) for Parkinson’s disease (PD), high levels of anatomic precision in terms of electrode placement can be obtained with patients under general anesthesia (GA) that may obviate the need for traditional awake intraoperative physiologic monitoring.
Methods: We conducted a literature review and meta-analysis of all published DBS for PD studies (N = 2276) on PubMed from 2006 to present day. Inclusion criteria included patient N > 15, report of precision and/or clinical outcomes data, and at least one year follow-up (N = 41, 9 of which were under GA). Results were stratified by type of anesthesia (GA versus local). Data were pooled using an inverse-variance weighted, random effects meta-analytic model for observational data.
Results: In terms of anatomic precision, there was no statistically significant difference in mean target error (1.671mm GA vs 1.916mm local, p = 0.596) and mean number of lead passes (1.799 GA vs 1.878 local, p = 0.778) between the two different modalities. In terms of clinical outcomes, change in UPDRS-III scores on and off medication were very similar (51.2% and 22.1% respectively for GA vs 52.8% and 18.5% for local respectively), as were decreases in levodopa equivalent doses (LEDD) (54.5% GA vs 49.3% local). Neither of these differences was statistically significant.
Conclusions: Though there still exists a paucity of outcomes data associated with DBS for PD procedures under GA, our comprehensive meta-analysis demonstrates no significant differences in anatomic precision and clinical outcomes between the two techniques. Thus, DBS under GA can be considered in patients who are not candidates for traditional awake DBS.
Patient Care: There currently exists considerable debate within the field regarding DBS for Parkinson’s conducted under awake or general anesthesia. The lack of definitive head-to-head outcomes data necessitates our meta-analysis of the recent literature to aid patients and neurosurgeons in their selection of the most appropriate procedure.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the latest DBS techniques for Parkinson’s under both general and local anesthesia
2) Understand the evidence behind asleep DBS with intraoperative imaging and awake DBS with intraoperative physiologic monitoring
3) Understand the current clinical equipoise within the literature and lack of more definitive asleep DBS outcomes data to help inform preferences between the two techniques