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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

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Physiological mapping during asleep procedures in patients with Parkinson’s disease – I. intraoperative microelectrode recordings

Physiologische Kartierung der subthalamischen Region von in Allgemeinanästhesie operierten Parkinson-Patienten – I. Mikroelektrodenableitungen

Meeting Abstract

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  • presenting/speaker Miriam Schaper - Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
  • Alessandro Gulberti - Universitätsklinikum Hamburg-Eppendorf, Institut für Neurophysiologie und Pathophysiologie, Hamburg, Deutschland
  • Wolfgang Hamel - Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
  • Monika Pötter-Nerger - 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
  • Andreas K. Engel - Universitätsklinikum Hamburg-Eppendorf, Institut für Neurophysiologie und Pathophysiologie, Hamburg, Deutschland
  • Christian Gerloff - Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurologie, Hamburg, Deutschland
  • Christian Zöllner - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Anästhesiologie, Hamburg, Deutschland
  • Manfred Westphal - Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
  • 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. DocV175

doi: 10.3205/20dgnc171, urn:nbn:de:0183-20dgnc1719

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 microelectrode recordings (MER) within the subthalamic region of awake patients with Parkinson’s disease (PD) to electrophysiological mapping results obtained during bilateral deep brain stimulation (DBS) surgery of the subthalamic nucleus (STN) under general anesthesia (GA)

Methods: We retrospectively reviewed and analyzed intraoperative MER from 51 consecutive PD patients (20F, 31M; age 61±10y; disease duration 12±4y) undergoing STN-DBS surgery under GA with propofol and remifentanil at our institution between 2015 and 2018. Data were compared to MER results from 51 consecutive PD patients (15F, 36M; age 62±7y; disease duration 11±4y) undergoing MER-guided STN-DBS surgery in the awake state.

Results: Both the dorsal and ventral STN boundaries could reliably be identified by a combination of single cell spiking properties and background changes under both anesthesia conditions. Crisp background changes at penetration of the fiber capsule alleviated mapping of the dorsal STN circumference during awake surgeries and lighter levels of GA, respectively. In contrast, the dorsal entry of the STN consistently appeared slightly deeper (~0.5mm) under GA, reflecting decreased activitiy levels of STN neurons. Deeper levels of anesthesia were generally associated with decreased discharge rates and increased burstiness of STN neurons, respectively. Despite these differences, the average hit rate was not significantly different between the two groups. Irrespective of anesthesia condition, we successfully confirmed the STN electrophysiologically in 80-90% of the trajectories. Furthermore, average recording length through the STN was ~5mm and did not differ between conditions. However, as expected, prevalence of oscillatory single cell activities at tremor (3-8Hz) and beta (12-35Hz) frequencies was significantly higher in awake patients compared to GA. Likewise, further physiological mapping could not be performed (e.g. somatotopic assessment of movement-related responses) or was unsuccessful (assessment of kinesthetic responses) during GA. Total recording duration was only slightly (~8min.) longer under GA.

Conclusion: General anesthesia with propofol and remifentanil has strong effects on neuronal activity in the parkinsonian STN. Nevertheless, MER-guided mapping of the subthalamic region can safely and reliably be performed under GA with high precision. We conclude that MER are a helpful tool for STN-DBS procedures performed under GA.