关键词: 脑深部电极植入, 帕金森病, 地氟烷, 微电极记录, 围术期认知

Abstract: Objective Feasibility application of microelectrode recording (MER) during sub thalamic nucleus deep brain stimulation (STN-DBS) implantation under desflurane general anesthesia(GA) in patients with Parkinson′s disease (PD). Methods A prospective cohort of 20 PD patients undergoing STN-DBS under desflurane general anesthesia were enrolled. Intraoperative MER quality, pos-operative acute pain, cognitive function, anxiety/depression status, quality of life, and clinical efficacy of DBS were evaluated. Results Among the patients, 14 were male with average PD duration of (8.1±3.6)years. Hoehn-Yahr staging averaged 2.8±0.5 in “on” state and 2.3±0.5 in “off” state. The mean DBS surgery duration was 87.4 minutes. Highly normalized root-mean-square (NRMS) signals were successfully recorded in all cases, with remedial measures applied in 4 patients to achieve satisfactory MER signals. Post-operative Visual Analogue Scale (VAS) pain scores on days 1, 2, and 3 were 3.7±2.2, 2.8±1.6,and 1.8±2.0, respectively. Montreal Cognitive Assessment (MoCA) scores showed no statistical difference during hospitalization as compared to pre-operative values, but significantly decreased at 6-month follow-up (24.3±4.1 vs. 21.5±3.5, P＜0.05). All patients demonstrated significant reduction in Hamilton Anxiety Scale (HAMA), Hamilton Depression Rating Scale (HAMD), and Parkinson′s disease Questionnaire-39 (PDQ-39) scores at 6-month follow-up. The unified Parkinson′s disease rating scale (UPDRS-Ⅲ) improvement rates were 51.4%±39.2% (medication-on) and 61.6%±26.8% (medication-off) respectively with Levodopa Equivalent Daily Dose (LEDD) improvement rate of 48.6%±23.0%. Conclusions Desflurane general anesthesia is safe and feasible for electrods implantation in STN-DBS of PD patients, without interfering with intra-operative MER or postoperative outcomes.

Key words: deep brain electrode implantation, Parkinson′s disease, desflurane, microelectrode recording, perioperative cognitive