Microelectrode assisted deep brain stimulation: Considerations for anesthesia

Deep brain stimulation (DBS) is a widely accepted and safe treatment for selected patients with movement disorders. Many medical centres prefer to perform DBS lead positioning using local anesthesia to enable microelectrode recordings (MER) and assess the therapeutic and side effects of stimulation. These steps allow for the precise identification of the borders and subdomains of the target nuclei using the electrophysiological properties. Additionally, they facilitate the evaluation of the therapeutic window and thereby improve the accuracy of final DBS lead placement. However, in some patients awake surgery can be challenging and, as a result, sedation or general anesthesia may be needed. Unfortunately, if not used properly this approach can lead to alterations in the electrophysiological signature and interfere with clinical testing, potentially affecting surgical outcomes. Consequently, the type and dose of anesthesia needs to be chosen carefully.