gms | German Medical Science

71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Article

Send article

Physiological mapping during asleep procedures in patients with Parkinson’s disease – II. intraoperative test-stimulation

Physiologische Kartierung der subthalamischen Region von in Allgemeinanästhesie operierten Parkinson-Patienten – II. intraoperative Teststimulation

Meeting Abstract

Search Medline for

  • Miriam Schaper - Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
  • Alessandro Gulberti - Universitätsklinikum Hamburg-Eppendorf, Institut für Neurophysiologie und Pathophysiologie, Hamburg, Deutschland; Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurologie, Hamburg, Deutschland
  • Johannes Köppen - Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
  • Ute Hidding - Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurologie, Hamburg, Deutschland
  • Carsten Buhmann - Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurologie, Hamburg, Deutschland
  • Simone Zittel - Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurologie, Hamburg, Deutschland
  • Chi-un Choe - Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurologie, Hamburg, Deutschland
  • Christian Zöllner - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Anästhesiologie, Hamburg, Deutschland
  • Andreas K. Engel - Universitätsklinikum Hamburg-Eppendorf, Institut für Neurophysiologie und Pathophysiologie, Hamburg, Deutschland
  • Manfred Westphal - Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
  • Christian Gerloff - Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurologie, Hamburg, Deutschland
  • Monika Pötter-Nerger - Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurologie, Hamburg, Deutschland
  • Wolfgang Hamel - Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
  • presenting/speaker Christian K. E. Moll - Universitätsklinikum Hamburg-Eppendorf, Institut für Neurophysiologie und Pathophysiologie, Hamburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV176

doi: 10.3205/20dgnc172, urn:nbn:de:0183-20dgnc1726

Published: June 26, 2020

© 2020 Schaper et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: To compare capsular side effect (SE) profiles and thresholds of intraoperative test stimulation obtained within the subthalamic region of awake Parkinson’s disease (PD) patients undergoing bilateral deep brain stimulation (DBS) surgery of the subthalamic nucleus (STN) with those obtained under general anesthesia (GA).

Methods: We retrospectively reviewed and analyzed intraoperative test stimulation protocols from 51 consecutive PD patients undergoing STN-DBS surgery under GA with propofol and remifentanil at our institution between 2015 and 2018. Data was compared to stimulation results obtained in 51 consecutive PD patients undergoing STN-DBS surgery under local anesthesia (LA). We employed bipolar DBS at the dorsal STN border with high-frequency (130Hz) trains of monophasic impulses. Pulse width was set to 60µs (LA) and 100µs (GA), respectively. Spread of the electrical field to neighbouring cortico-spinal and cortico-bulbar motor fibers was assessed both clinically and with electromyography (EMG). To this end, surface polymyography was routinely performed in every case.

Results: Irrespective of anesthesia condition, capsular SE were sucessfully elicited intraoperatively in all patients. Both under LA and GA, lateral trajectories had significantly lower SE thresholds (LA, 3.4±1.2mA/GA, 3.0±1.0mA) compared to central (LA, 4.3±1.3mA/GA, 4.1±0.9mA) and anterior (LA, 5.2±1.6mA/GA, 4.7±1.2mA) tracks, as judged clinically (p<0.01). Notably, capsular thresholds did not differ between anesthesia conditions, when adjusting for total electrical energy delivered (p>0.05). Stimulation-induced tetanic muscle contractions (TMC) predominantly affected face and arm muscles. TMC thresholds for face and arm were not significantly different (p>0.05). Transient paresthesia—consistently reported by awake patients ~0.5mA below TMC threshold—and stimulation-induced dysarthria could not be assessed during GA. It is of note that the earliest signs of capsular spread under GA (activation of single muscle fibers) were visible in the EMG long before TMC was apparent upon visual inspection (EMG threshold, 3.5±0.9mA/visual threshold, 4.6±0.7mA; p<0.0001).

Conclusion: We conclude that, regardless of the anesthetic regimen and despite obvious limitations, intraooperative test stimulation – especially in conjunction with polymyography – provides a detailed account of capsular spread during STN-DBS surgery and may be key to a successful surgical outcome.