Anesthesia for Pediatric Deep Brain Stimulation Surgery

Abstract

There is a broad spectrum of neurological illnesses in pediatric patients leading to movement disorders and finally affecting the developmental and functional capacities. Historically, functional neurological disorders like Parkinson’s disease were treated with surgeries like thalamotomy, pallidotomy, and cingulotomy, which involved mainly the lesioning of deep brain structures. These procedures were irreversible and frequently associated with various permanent side effects. Wertheimer, a psychologist, compiled a book on movement disorders for the first time, while Otfrid Foerster, a German neurologist and neurosurgeon, has been recognized as the pioneer of surgery for movement disorder. In 1960, advances in stimulator technology and Melzack and Wall’s gate theory initiated a paradigm shift tiled the way for deep brain stimulation (DBS). In 1987, DBS was finally recognized as an alternative to the ablation procedures for reducing symptoms of Parkinson’s disease. Advantages like reversibility, the possibility of bilateral stimulation, ability to titrate the stimulation dose and safety, and long-term benefits have made DBS a favorable option for not only Parkinson’s disease but also many functional neurosurgery procedures. The other indications of DBS are juvenile parkinsonism, Tourette’s syndrome, pediatric obesity, epilepsy, and obsessive-compulsive disorder (OCD). In the entire spectrum of childhood movement disorders, dystonia is the most common, most severe, and most challenging movement disorder. The management of such movement disorder needs a multidisciplinary approach that includes a neurologist, neurosurgeon, neuroanesthesiologist, neuropsychologist, nursing staff, and physiotherapist to help in rehabilitation.