Subthalamic deep brain stimulation after anesthetic inhalation in Parkinson disease: a preliminary study

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The authors of this preliminary study investigated the outcome and feasibility of intraoperative microelectrode recording (MER) in patients with Parkinson disease (PD) undergoing deep brain stimulation of the subthalamic nucleus (STN) after anesthetic inhalation.


The authors conducted a retrospective analysis of 10 patients with PD who received a desflurane anesthetic during bilateral STN electrode implantation. The MERs were obtained as an intraoperative guide for final electrode implantation and the data were analyzed offline. The functional target coordinates of the electrodes were compared preoperatively with estimated target coordinates.


Outcomes were evaluated using the Unified Parkinson's Disease Rating Scale 6 months after surgery. The mean improvement in total and motor Unified Parkinson's Disease Rating Scale scores was 54.27 ± 17.96% and 48.85 ± 16.97%, respectively. The mean STN neuronal firing rate was 29.7 ± 14.6 Hz. Typical neuronal firing patterns of the STN and substantia pars nigra reticulata were observed in each patient during surgery. Comparing the functional target coordinates, the z axis coordinates were noted to be significantly different between the pre- and postoperative coordinates.


The authors found that MER can be adequately performed while the patient receives a desflurane anesthetic, and the results can serve as a guide for STN electrode implantation. This may be a good alternative surgical method in patients with PD who are unable to tolerate deep brain stimulation surgery with local anesthesia.

Abbreviations used in this paper: DBS = deep brain stimulation; MAC = minimal alveolar concentration; MER = microelectrode recording; PD = Parkinson disease; SD = standard deviation; SNr = substantia pars nigra reticulata; STN = subthalamic nucleus; UPDRS = Unified Parkinson's Disease Rating Scale.

Article Information

Address correspondence to: Shin-Yuan Chen, M.D., M.Sc., Department of Neurosurgery, Tzu Chi General Hospital, 707, Sec. 3, Chung-Yang Road, Hualien, 970, Taiwan. email:

© AANS, except where prohibited by US copyright law.



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    Case 10. Upper: Microelectrode recording showing movement-related STN neuron firing in a patient when his contralateral hip was flexed (passive movement). Lower: Root mean square (RMS) of neuronal discharge in this recording. After passive movement, the increased RMS of neuronal firing is compatible with the alteration in neuronal discharge.

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    Case 10. Microelectrode recordings obtained during STN DBS surgery, and sagittal diagram of 2 electrode tracks showing the location of 1, thalamic bursting cell; 2, sparse cell firing in the zona incerta; 3, STN bursting neuron; 4, SNr neuron; and 5, the movement-related STN neuron presented in Fig. 1.


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