Anaesthesia for Deep Brain Stimulation
Anaesthesia for Deep Brain Stimulation
Deep brain stimulation has become an increasingly common treatment for Parkinson's disease and other movement disorders. Consequently, it is important to understand the concepts of appropriate patient selection, the implantation process, and the various drugs and techniques that can be used to facilitate this treatment. Currently, none of the anaesthetic techniques for neurostimulator implantation has proven to be superior to others, although awake or sedation techniques are popular as they facilitate intraoperative neurological testing. However, even with meticulous anaesthetic care, perioperative complications such as hypertension and seizures do occasionally occur and close monitoring is required. Anaesthesia in patients with an implanted neurostimulator requires special considerations because of possible interference between neurostimulators and other devices. We have reviewed the current knowledge of anaesthetic techniques and perioperative complications of neurostimulator insertion. Anaesthetic considerations in patients with an implanted neurostimulator are also discussed.
Functional stereotactic neurosurgery has become an increasing common treatment over the past 10 yr. In particular, deep brain stimulation (DBS) is now an effective treatment for Parkinson's disease. Thalamic DBS was first developed for tremor control. Subsequently, subthalamic nucleus (STN) and internal globus palludus (GPi) stimulation were also investigated. In particular, STN stimulation can improve a wide range of parkinsonian symptoms and is currently the preferred target for most patients with this disease. The exact mechanism of action of this neurostimulation, however, remains unclear. Nonetheless, after this initial success in patients with Parkinson's disease, the indications and applications for DBS have expanded to other disorders such as essential tremor, dystonia, chronic pain, and psychiatric disorders. When STN DBS is contraindicated, thalamic DBS remains an option for patients with severe tremor, and GPi stimulation can be used for those with severe dyskinesia.
The most common DBS hardware used (Medtronic, USA) has four main components: (i) the multicontact intracranial quadripolar electrodes, which are surgically inserted into the deep brain unilaterally or bilaterally, (ii) a plastic ring and cap seated onto a burr hole to fix the electrodes to the skull, (iii) a single- or dual-channel internal pulse generator (IPG), and (iv) an extension cable that is tunnelled s.c. from the cranial area to the chest or abdomen, connecting the DBS electrode(s) to the IPG. The battery lasts between 2 and 5 yr and has to be replaced together with the pulse generator.
This article reviews the current knowledge regarding anaesthetic techniques for neurostimulator insertion. After a description of the surgical procedure, anaesthetic issues and possible perioperative complications will be discussed. Finally, anaesthesia for patients with a neurostimulator implant will be considered.
Abstract and Introduction
Abstract
Deep brain stimulation has become an increasingly common treatment for Parkinson's disease and other movement disorders. Consequently, it is important to understand the concepts of appropriate patient selection, the implantation process, and the various drugs and techniques that can be used to facilitate this treatment. Currently, none of the anaesthetic techniques for neurostimulator implantation has proven to be superior to others, although awake or sedation techniques are popular as they facilitate intraoperative neurological testing. However, even with meticulous anaesthetic care, perioperative complications such as hypertension and seizures do occasionally occur and close monitoring is required. Anaesthesia in patients with an implanted neurostimulator requires special considerations because of possible interference between neurostimulators and other devices. We have reviewed the current knowledge of anaesthetic techniques and perioperative complications of neurostimulator insertion. Anaesthetic considerations in patients with an implanted neurostimulator are also discussed.
Introduction
Functional stereotactic neurosurgery has become an increasing common treatment over the past 10 yr. In particular, deep brain stimulation (DBS) is now an effective treatment for Parkinson's disease. Thalamic DBS was first developed for tremor control. Subsequently, subthalamic nucleus (STN) and internal globus palludus (GPi) stimulation were also investigated. In particular, STN stimulation can improve a wide range of parkinsonian symptoms and is currently the preferred target for most patients with this disease. The exact mechanism of action of this neurostimulation, however, remains unclear. Nonetheless, after this initial success in patients with Parkinson's disease, the indications and applications for DBS have expanded to other disorders such as essential tremor, dystonia, chronic pain, and psychiatric disorders. When STN DBS is contraindicated, thalamic DBS remains an option for patients with severe tremor, and GPi stimulation can be used for those with severe dyskinesia.
The most common DBS hardware used (Medtronic, USA) has four main components: (i) the multicontact intracranial quadripolar electrodes, which are surgically inserted into the deep brain unilaterally or bilaterally, (ii) a plastic ring and cap seated onto a burr hole to fix the electrodes to the skull, (iii) a single- or dual-channel internal pulse generator (IPG), and (iv) an extension cable that is tunnelled s.c. from the cranial area to the chest or abdomen, connecting the DBS electrode(s) to the IPG. The battery lasts between 2 and 5 yr and has to be replaced together with the pulse generator.
This article reviews the current knowledge regarding anaesthetic techniques for neurostimulator insertion. After a description of the surgical procedure, anaesthetic issues and possible perioperative complications will be discussed. Finally, anaesthesia for patients with a neurostimulator implant will be considered.
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