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Andre A. Wakim, Jennifer B. Mattar, Margaret Lambert, and Francisco A. Ponce

complications in functional neurosurgery: a large case series and systematic literature review . J Neurosurg . 2012 ; 116 ( 1 ): 84 – 94 . 16 Levi V , Carrabba G , Rampini P , Locatelli M . Short term surgical complications after subthalamic deep brain stimulation for Parkinson’s disease: does old age matter? BMC Geriatr . 2015 ; 15 : 116 . 17 Verla T , Marky A , Farber H , Impact of advancing age on post-operative complications of deep brain stimulation surgery for essential tremor . J Clin Neurosci . 2015 ; 22 ( 5 ): 872 – 876 . 18 Nagata K

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Tsinsue Chen, Zaman Mirzadeh, Kristina Chapple, Margaret Lambert, and Francisco A. Ponce

Weaver FM , Follett K , Stern M , Hur K , Harris C , Marks WJ Jr , : Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial . JAMA 301 : 63 – 73 , 2009 10.1001/jama.2008.929 19126811 45 Zrinzo L , Foltynie T , Limousin P , Hariz MI : Reducing hemorrhagic complications in functional neurosurgery: a large case series and systematic literature review . J Neurosurg 116 : 84 – 94 , 2012 10.3171/2011.8.JNS101407 21905798

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Tsinsue Chen, Zaman Mirzadeh, Kristina Chapple, Margaret Lambert, Rohit Dhall, and Francisco A. Ponce

25 Papanastassiou V , Rowe J , Scott R , Silburn P , Davies L , Aziz T : Use of the Radionics Image Fusion™ and Stereoplan™ programs for target localization in functional neurosurgery . J Clin Neurosci 5 : 28 – 32 , 1998 26 Pezeshkian P , DeSalles AA , Gorgulho A , Behnke E , McArthur D , Bari A : Accuracy of frame-based stereotactic magnetic resonance imaging vs frame-based stereotactic head computed tomography fused with recent magnetic resonance imaging for postimplantation deep brain stimulator lead localization

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Tsinsue Chen, Zaman Mirzadeh, Kristina M. Chapple, Margaret Lambert, Holly A. Shill, Guillermo Moguel-Cobos, Alexander I. Tröster, Rohit Dhall, and Francisco A. Ponce

-verified deep brain stimulation . Mov Disord 28 : 254 , 2013 ( Letter ) 23390009 10.1002/mds.25302 35 Zrinzo L , Foltynie T , Limousin P , Hariz MI : Reducing hemorrhagic complications in functional neurosurgery: a large case series and systematic literature review . J Neurosurg 116 : 84 – 94 , 2012 10.3171/2011.8.JNS101407 21905798

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Tsinsue Chen, Zaman Mirzadeh, Kristina M. Chapple, Margaret Lambert, Virgilio G. H. Evidente, Guillermo Moguel-Cobos, Srivadee Oravivattanakul, Padma Mahant, and Francisco A. Ponce

OBJECTIVE

Ventral intermediate nucleus deep brain stimulation (DBS) for essential tremor is traditionally performed with intraoperative test stimulation and conscious sedation, without general anesthesia (GA). Recently, the authors reported retrospective data on 17 patients undergoing DBS after induction of GA with standardized anatomical coordinates on T1-weighted MRI sequences used for indirect targeting. Here, they compare prospectively collected data from essential tremor patients undergoing DBS both with GA and without GA (non-GA).

METHODS

Clinical outcomes were prospectively collected at baseline and 3-month follow-up for patients undergoing DBS surgery performed by a single surgeon. Stereotactic, euclidean, and radial errors of lead placement were calculated. Functional (activities of daily living), quality of life (Quality of Life in Essential Tremor [QUEST] questionnaire), and tremor severity outcomes were compared between groups.

RESULTS

Fifty-six patients underwent surgery: 16 without GA (24 electrodes) and 40 with GA (66 electrodes). The mean baseline functional scores and QUEST summary indices were not different between groups (p = 0.91 and p = 0.59, respectively). Non-GA and GA groups did not differ significantly regarding mean postoperative percentages of functional improvement (non-GA, 47.9% vs GA, 48.1%; p = 0.96) or QUEST summary indices (non-GA, 79.9% vs GA, 74.8%; p = 0.50). Accuracy was comparable between groups (mean radial error 0.9 ± 0.3 mm for non-GA and 0.9 ± 0.4 mm for GA patients) (p = 0.75). The mean euclidean error was also similar between groups (non-GA, 1.1 ± 0.6 mm vs GA, 1.2 ± 0.5 mm; p = 0.92). No patient had an intraoperative complication, and the number of postoperative complications was not different between groups (non-GA, n = 1 vs GA, n = 10; p = 0.16).

CONCLUSIONS

DBS performed with the patient under GA to treat essential tremor is as safe and effective as traditional DBS surgery with intraoperative test stimulation while the patient is under conscious sedation without GA.

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Zaman Mirzadeh, Kristina Chapple, Margaret Lambert, Virgilio G. Evidente, Padma Mahant, Maria C. Ospina, Johan Samanta, Guillermo Moguel-Cobos, Naomi Salins, Abraham Lieberman, Alexander I. Tröster, Rohit Dhall, and Francisco A. Ponce

L , Foltynie T , Limousin P , Hariz MI : Reducing hemorrhagic complications in functional neurosurgery: a large case series and systematic literature review . J Neurosurg 116 : 84 – 94 , 2012