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Brain Sci. 2018, 8(1), 17; https://doi.org/10.3390/brainsci8010017

Awake versus Asleep Deep Brain Stimulation Surgery: Technical Considerations and Critical Review of the Literature

Department of Neurosurgery, Rush University Medical Center, Chicago, IL 60612, USA
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Received: 15 December 2017 / Revised: 8 January 2018 / Accepted: 16 January 2018 / Published: 19 January 2018
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Abstract

Advancements in neuroimaging have led to a trend toward direct, image-based targeting under general anesthesia without the use of microelectrode recording (MER) or intraoperative test stimulation, also referred to as “asleep” deep brain stimulation (DBS) surgery. Asleep DBS, utilizing imaging in the form of intraoperative computed tomography (iCT) or magnetic resonance imaging (iMRI), has demonstrated reliable targeting accuracy of DBS leads implanted within the globus pallidus and subthalamic nucleus while also improving clinical outcomes in patients with Parkinson’s disease. In lieu, of randomized control trials, retrospective comparisons between asleep and awake DBS with MER have shown similar short-term efficacy with the potential for decreased complications in asleep cohorts. In lieu of long-term outcome data, awake DBS using MER must demonstrate more durable outcomes with fewer stimulation-induced side effects and lead revisions in order for its use to remain justifiable; although patient-specific factors may also be used to guide the decision regarding which technique may be most appropriate and tolerable to the patient. View Full-Text
Keywords: awake; asleep; DBS; targeting; stereotaxis awake; asleep; DBS; targeting; stereotaxis
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Kochanski, R.B.; Sani, S. Awake versus Asleep Deep Brain Stimulation Surgery: Technical Considerations and Critical Review of the Literature. Brain Sci. 2018, 8, 17.

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