Asleep Robot-Assisted Surgery for the Implantation of Subthalamic Electrodes Provides the Same Clinical Improvement and Therapeutic Window as Awake Surgery

Autor: Philippe Merle, Pierre Krystkowiak, Michel Lefranc, Mélissa Tir, Jean-Marc Constans, Olivier Godefroy, Johann Peltier, Yassine Zouitina, Martial Ouendo
Přispěvatelé: CHU Amiens-Picardie, Service de neurologie [Amiens], Laboratoire de Neurosciences Fonctionnelles et Pathologies - UR UPJV 4559 (LNFP), Université de Picardie Jules Verne (UPJV), Université de Lille, Sciences et Technologies, Self-adaptation for distributed services and large software systems (SPIRALS), Inria Lille - Nord Europe, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre de Recherche en Informatique, Signal et Automatique de Lille - UMR 9189 (CRIStAL), Centrale Lille-Université de Lille-Centre National de la Recherche Scientifique (CNRS)-Centrale Lille-Université de Lille-Centre National de la Recherche Scientifique (CNRS), Service de Radiologie [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN)
Rok vydání: 2017
Předmět:
Male
Cognition Disorders/etiology
Parkinson's disease
[SDV]Life Sciences [q-bio]
medicine.medical_treatment
Deep Brain Stimulation
General/methods
Conscious Sedation
Deep Brain Stimulation/*instrumentation/methods
Wakefulness/physiology
030218 nuclear medicine & medical imaging
0302 clinical medicine
Postoperative Complications
Robotic Surgical Procedures
Clinical endpoint
Medicine
Anesthesia
Local anesthesia
Lead (electronics)
Local/methods
Therapeutic window
Parkinson Disease
Middle Aged
Electrodes
Implanted
Subthalamic nucleus
ROSA robot
surgical procedures
operative
Treatment Outcome
Postoperative Complications/etiology
Wakefulness
Female
medicine.medical_specialty
Deep brain stimulation
Apathy
Parkinson Disease/*therapy
Mood Disorders/etiology
Anesthesia
General
03 medical and health sciences
Subthalamic Nucleus
Humans
Electrodes
Conscious Sedation/methods
business.industry
Mood Disorders
medicine.disease
Robotic Surgical Procedures/adverse effects/*methods
nervous system diseases
Surgery
Subthalamic Nucleus/surgery
Robot-assisted electrode placement
Apathy/physiology
Implanted
Neurology (clinical)
business
Cognition Disorders
030217 neurology & neurosurgery
Anesthesia
Local
Zdroj: World Neurosurgery
World Neurosurgery, 2017, 106, pp.602--608. ⟨10.1016/j.wneu.2017.07.047⟩
ISSN: 1878-8769
1878-8750
DOI: 10.1016/j.wneu.2017.07.047⟩
Popis: Place: United States; International audience; OBJECTIVE: To study the impact of not performing awake clinical evaluation during the robot-assisted implantation of subthalamic nucleus deep brain stimulation (STN-DBS) electrodes on the stimulation parameters and clinical outcomes in patients with Parkinson disease (PD). METHODS: A total of 23 patients with PD underwent robot-assisted surgery for the bilateral implantation of STN-DBS electrodes. Thirteen patients received general anesthesia (GA) and a limited intraoperative evaluation (side effects only), and the other 10 patients received local anesthesia (LA) and a full evaluation. The primary endpoint was the therapeutic window (TW), defined as the difference between the mean voltage threshold for motor improvement and the mean voltage threshold for side effects in the active contacts at 12 months after surgery. Motor scores were measured as well. RESULTS: The TW was similar in the LA and GA groups, with mean ± standard deviation values of 2.06 ± 0.53 V and 2.28 ± 0.99 V, respectively (P = 0.32). In the short term, the Unified Parkinson Disease Rating Scale (UPDRS) III score in the "off-drug, on-stim" condition fell to a similar extent in the LA and GA groups (by 40.3% and 49%, respectively; P = 0.336), as did the UPDRS III score in the "on-stim, on-drug" condition (by 57% and 70.7%, respectively; P = 0.36). CONCLUSIONS: Asleep, robot-assisted implantation of STN-DBS electrodes (with accurate identification of the STN and positioning of the DBS lead) produced the same motor results and TW as awake surgery.
Databáze: OpenAIRE
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