Anesthesiology pp 589-596 | Cite as

Functional Brain Surgery (Stereotactic Surgery, Deep Brain Stimulation)

  • Ilyas Qazi
  • Hannah Church


Deep Brain stimulation (DBS) as a neurosurgical treatment modality for movement disorders has evolved significantly since its inception in the early 80s. With rapid technological advancements, the scope of DBS has expanded and now encompasses treatment for refractory epilepsy, chronic pain conditions and certain neuropsychiatric disorders.

The minimally invasive nature of DBS surgery provides a better patient safety and recovery profile when compared to permanent and often more invasive neurosurgical lesioning techniques. Although, the understanding of the postulated mechanisms of DBS treatment is constantly evolving, it continues to offer a modern-day remedy for refractory movement disorders.

The anesthetic considerations for DBS surgery are wide-ranging and any peri-operative planning mandates a multi-disciplinary approach. The anesthetic challenges are not just limited to the provision of sound anesthetic care during the implantation of DBS electrodes but also extend to situations where patients with deep brain stimulators present for non-DBS related surgeries.


Parkinson’s disease Deep brain stimulation Subthalamic nuclei Substantia nigra Intraoperative electrophysiology 


  1. 1.
    Miocinovic S, Somayajula S, Chitnis S, Vitek JL. History, applications, and mechanisms of deep brain stimulation. JAMA Neurol. 2013;70:163–71.CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Sharma M, Naik V, Deogaonkar M. Emerging applications of deep brain stimulation. J Neurosurg Sci. 2016;60(2):242–55.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Williams NR, Okun MS. Deep brain stimulation (DBS) at the interface of neurology and psychiatry. J Clin Invest. 2013;123(11):4546–56.CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Benabid AL, Pollak P, Louveau A, et al. Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Appl Neurophysiol. 1987;50:344–6.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Okun MS. Deep-brain stimulation for Parkinson’s disease. N Engl J Med. 2012;367:1529–38.CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Davie CA. A review of Parkinson’s disease. Br Med Bull. 2008;86(1):109–27.CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    DeMaagd G, Philip A. Parkinson’s disease and its management: part 1: disease entity, risk factors, pathophysiology, clinical presentation, and diagnosis. P T. 2015;40(8):504–32.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Massano J, Bhatia KP. Clinical approach to Parkinson’s disease: features, diagnosis, and principles of management. Cold Spring Harb Perspect Med. 2012;2(6):a008870.CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Venkatraghavan L, Luciano M, Manninen P. Anesthetic management of patients undergoing deep brain stimulator insertion. Anesth Analg. 2010;110:1138–45.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Larson PS. Deep brain stimulation for movement disorders. Neurotherapeutics. 2014;11(3):465–74.CrossRefPubMedCentralPubMedGoogle Scholar
  11. 11.
    Kocabicak E, Temel Y, Hollig A, et al. Current perspectives on deep brain stimulation for severe neurological and psychiatric disorders. Neuropsychiatr Dis Treat. 2015;11:1051–66.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Benabid AL, Torres N. New targets for DBS. Parkinsonism Relat Disord. 2012;18:S21–3.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Johnson MD, Miocinovic S, McIntyre CC, Vitek JL. Mechanisms and targets of deep brain stimulation in movement disorders. Neurotherapeutics. 2008;5:294–308.CrossRefPubMedCentralPubMedGoogle Scholar
  14. 14.
    Grant R, Gruenbaum SE, Gerrard J. Anaesthesia for deep brain stimulation: a review. Curr Opin Anaesthesiol. 2015;28:505–10.CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    Scharpf DT, Sharma M, Deogaonkar M, et al. Practical considerations and nuances in anesthesia for patients undergoing deep brain stimulation implantation surgery. Korean J Anesthesiol. 2015;68:332–9.CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Venkatraghavan L, Manninen P. Anesthesia for deep brain stimulation. Curr Anesthesiol Rep. 2016;6(3):233–43.CrossRefGoogle Scholar
  17. 17.
    Sharma M, Rhiew R, Deogaonkar M, et al. Accuracy and precision of targeting using frameless stereotactic system in deep brain stimulator implantation surgery. Neurol India. 2014;62:503–9.CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Sharma M, Deogaonkar M. Accuracy and safety using intraoperative O-arm during placement of deep brain stimulation electrodes without electrophysiological recordings. J Clin Neurosci. 2016;27:80–6.CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Erickson KM, Cole DJ. Anesthetic considerations for awake craniotomy for epilepsy and functional neurosurgery. Anesthesiol Clin. 2012;30:241–68.CrossRefPubMedCentralPubMedGoogle Scholar
  20. 20.
    Yeoh TY, Manninen P, Kalia SK, Venkatraghavan L. Anesthesia considerations for patients with an implanted deep brain stimulator undergoing surgery: a review and update. Can J Anesth. 2017;64:308–19.CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
    Chen SY, Tsai ST, Lin SH, et al. Subthalamic deep brain stimulation in Parkinson’s disease under different anesthetic modalities: a comparative cohort study. Stereotact Funct Neurosurg. 2011;89:372–80.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Kim W, Song IH, Lim YH, et al. Influence of propofol and fentanyl on deep brain stimulation of the subthalamic nucleus. J Korean Med Sci. 2014;29(9):1278–86.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Kwon WK, Kim JH, Lee JH, et al. Microelectrode recording (MER) findings during sleep-awake anesthesia using dexmedetomidine in deep brain stimulation surgery for Parkinson’s disease. Clin Neurol Neurosurg. 2016;143:27–33.CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Martinez-Simon A, Alegre M, Honorato-Cia C, et al. Effect of dexmedetomidine and propofol on basal ganglia activity in Parkinson disease: a controlled clinical trial. Anesthesiology. 2017;126(6):1033–42.CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Bindu B, Bithal PK. Anaesthesia and deep brain stimulation. J Neuroanaesthesiol Crit Care. 2016;3:197–204.CrossRefGoogle Scholar
  26. 26.
    Chen T, Mirzadeh Z, Chapple K, et al. “Asleep” deep brain stimulation for essential tremor. J Neurosurg. 2015;27:1–8.Google Scholar
  27. 27.
    Mann JM, Foote KD, Garvan CW, et al. Brain penetration effects of microelectrodes and DBS leads in STN or GPi. J Neurol Neurosurg Psychiatry. 2009;80:794–7.CrossRefPubMedCentralPubMedGoogle Scholar
  28. 28.
    Moro E, Lozano AM, Pollak P, et al. Long-term results of a multicenter study on subthalamic and pallidal stimulation in Parkinson’s disease. Mov Disord. 2010;25:578–86.CrossRefPubMedCentralPubMedGoogle Scholar
  29. 29.
    Fenoy FJ, Simpson RK Jr. Risks of common complications in deep brain stimulation surgery: management and avoidance. J Neurosurg. 2014;120:132–9.CrossRefPubMedCentralPubMedGoogle Scholar
  30. 30.
    Venkatraghavan L, Chinnapa V, Peng P, Brull R. Non-cardiac implantable electrical devices: brief review and implications for anesthesiologists. Can J Anaesth. 2009;56:320–6.CrossRefPubMedCentralPubMedGoogle Scholar
  31. 31.
    Nutt JG, Anderson VC, Peacock JH, et al. DBS and diathermy interaction induces severe CNS damage. Neurology. 2001;56:1384–6.CrossRefPubMedCentralPubMedGoogle Scholar
  32. 32.
    Poon CC, Irwin MG. Anaesthesia for deep brain stimulation and in patients with implanted neurostimulator devices. Br J Anaesth. 2009;103:152–65.CrossRefPubMedCentralPubMedGoogle Scholar
  33. 33.
    Larson PS, Richardson RM, Starr PA, Martin AJ. Magnetic resonance imaging of implanted deep brain stimulators: experience in a large series. Stereotact Funct Neurosurg. 2008;86:92–100.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Ilyas Qazi
    • 1
  • Hannah Church
    • 1
  1. 1.Queen Elizabeth HospitalBirminghamUK

Personalised recommendations