How I do it — asleep DBS placement for Parkinson’s disease

• Published in: Acta neurochirurgica Vol. 165; no. 8; pp. 2189 - 2195
• Main Authors: Roldan, Pedro, Mosteiro, Alejandra, Valldeoriola, Francesc, Rumià, Jordi
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.08.2023; Springer Nature B.V
• Subjects: Anesthesia; Brain; Deep Brain Stimulation - methods; Electrodes; Functional Neurosurgery – Movement disorders; General anesthesia; How I Do it; Humans; Interventional Radiology; Iodine; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Movement disorders; Neurodegenerative diseases; Neuroimaging; Neurology; Neuroradiology; Neurosurgery; Neurosurgical Procedures - methods; Parkinson Disease - diagnostic imaging; Parkinson Disease - therapy; Parkinson's disease; Surgery; Surgical Orthopedics; OARM; Subthalamic nucleus; DBS; Asleep; Parkinson
• ISSN: 0942-0940; 0001-6268; 0942-0940
• DOI: 10.1007/s00701-023-05659-7

Background Traditionally, functional neurosurgery relied in stereotactic atlases and intraoperative micro-registration in awake patients for electrode placement in Parkinson’s disease. Cumulative experience on target description, refinement of MRI, and advances in intraoperative imaging has enabled accurate preoperative planning and its implementation with the patient under general anaesthesia. Methods Stepwise description, emphasising preoperative planning, and intraoperative imaging verification, for transition to asleep-DBS surgery. Conclusion Direct targeting relies on MRI anatomic landmarks and accounts for interpersonal variability. Indeed, the asleep procedure precludes patient distress. A particular complication to avoid is pneumocephalus; it can lead to brain-shift and potential deviation of electrode trajectory.