Awake versus Asleep Deep Brain Stimulation Surgery: Technical Considerations and Critical Review of the Literature.
Ryan B KochanskiSepehr SaniPublished in: Brain sciences (2018)
Advancements in neuroimaging have led to a trend toward direct, image-based targeting under general anesthesia without the use of microelectrode recording (MER) or intraoperative test stimulation, also referred to as "asleep" deep brain stimulation (DBS) surgery. Asleep DBS, utilizing imaging in the form of intraoperative computed tomography (iCT) or magnetic resonance imaging (iMRI), has demonstrated reliable targeting accuracy of DBS leads implanted within the globus pallidus and subthalamic nucleus while also improving clinical outcomes in patients with Parkinson's disease. In lieu, of randomized control trials, retrospective comparisons between asleep and awake DBS with MER have shown similar short-term efficacy with the potential for decreased complications in asleep cohorts. In lieu of long-term outcome data, awake DBS using MER must demonstrate more durable outcomes with fewer stimulation-induced side effects and lead revisions in order for its use to remain justifiable; although patient-specific factors may also be used to guide the decision regarding which technique may be most appropriate and tolerable to the patient.
Keyphrases
- deep brain stimulation
- parkinson disease
- magnetic resonance imaging
- obsessive compulsive disorder
- computed tomography
- minimally invasive
- coronary artery bypass
- cancer therapy
- high resolution
- positron emission tomography
- double blind
- open label
- contrast enhanced
- deep learning
- risk factors
- drug delivery
- high glucose
- surgical site infection
- electronic health record
- acute coronary syndrome
- coronary artery disease
- risk assessment
- insulin resistance
- skeletal muscle
- phase iii
- randomized controlled trial
- human health
- placebo controlled
- climate change
- artificial intelligence
- percutaneous coronary intervention
- diffusion weighted imaging
- stress induced
- study protocol