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STN DBS for Parkinson’s disease: results from a series of ten consecutive patients implanted under general anaesthesia with intraoperative use of 3D fluoroscopy to control lead placement

  • Clinical Article - Neurosurgical Techniques
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Abstract

Background

Deep brain stimulation (DBS) of the sub-thalamic nucleus (STN) is a recognised treatment for advanced Parkinson’s disease (PD). We present our results of 10 consecutive patients implanted under general anaesthesia (GA) using intraoperative robotic three-dimensional (3D) fluoroscopy (Artis Zeego; Siemens, Erlangen, Germany).

Method

Ten patients (nine men, one woman) with a mean age of 57.6 (range, 41–67) years underwent surgery between October 2013 and January 2015. The mean duration of PD was 9.2 [1–10] year. The procedure was performed under GA: placement of the stereotactic frame, implantation of the electrodes (Lead 3389; Medtronic, Minnesota, MN, USA) and 3D intraoperative fluoroscopic control (Artis Zeego) with image fusion with the preoperative MRI scans. All patients were evaluated preoperatively and 6 months postoperatively.

Results

The mean operative time was 240.1 (185–325) min. The mean Unified Parkinson’s Disease Rating Scale (UPDRS) II OFF medication decreased from 23.9 preoperatively to 15.7 postoperatively. The mean OFF medication UPDRS III decreased from 41 to 11.6 and the UPDRS IV decreased from 10.6 to 7. The mean preoperative and postoperative L-Dopa doses were 1,178.5 and 696.5 mg, respectively. Two complications were recorded: one episode of transient confusion (24 h) and one internal pulse generator (IPG) infection.

Conclusions

With improvement in preoperative magnetic resonance imaging (MRI) and the ability to control the position of the leads intraoperatively using Artis Zeego, we now perform this procedure under GA. Our results are comparable to others reported. The significant decrease in the duration of surgery could be associated with a reduced rate of complications (infection, loss of patient collaboration). However, this observation needs to be confirmed.

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Authors and Affiliations

  1. Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Avenue Hippocrate, 10 1200, Brussels, Belgium

    Maxime Delavallée, Julien Delaunois, Jean Ruwet & Christian Raftopoulos

  2. Department of Neurology, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Brussels, Belgium

    Anne Jeanjean

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  1. Maxime Delavallée
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  2. Julien Delaunois
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Correspondence to Christian Raftopoulos.

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All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Delavallée, M., Delaunois, J., Ruwet, J. et al. STN DBS for Parkinson’s disease: results from a series of ten consecutive patients implanted under general anaesthesia with intraoperative use of 3D fluoroscopy to control lead placement. Acta Neurochir 158, 1783–1788 (2016). https://doi.org/10.1007/s00701-016-2889-y

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  • DOI: https://doi.org/10.1007/s00701-016-2889-y

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