Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/28327
Title: Electrically evoked and spontaneous neural activity in the subthalamic nucleus under general anesthesia.
Austin Authors: Sinclair, Nicholas C;McDermott, Hugh J;Lee, Wee-Lih;Xu, San San ;Acevedo, Nicola;Begg, Angus;Perera, Thushara;Thevathasan, Wesley;Bulluss, Kristian J 
Affiliation: Department of Medicine, The University of Melbourne, Parkville
Medical Bionics Department, The University of Melbourne, East Melbourne
Bionics Institute, East Melbourne
Neurology
Bionics Institute, East Melbourne
Department of Neurosurgery, St. Vincent's and Austin Hospitals, Melbourne
Department of Surgery, The University of Melbourne, Heidelberg, Victoria, Australia
Issue Date: 10-Dec-2021
Date: 2021-12-10
Publication information: Journal of Neurosurgery 2021; online first: 10 December
Abstract: Deep brain stimulation (DBS) surgery is commonly performed with the patient awake to facilitate assessments of electrode positioning. However, awake neurosurgery can be a barrier to patients receiving DBS. Electrode implantation can be performed with the patient under general anesthesia (GA) using intraoperative imaging, although such techniques are not widely available. Electrophysiological features can also aid in the identification of target neural regions and provide functional evidence of electrode placement. Here we assess the presence and positional variation under GA of spontaneous beta and high-frequency oscillation (HFO) activity, and evoked resonant neural activity (ERNA), a novel evoked response localized to the subthalamic nucleus. ERNA, beta, and HFO were intraoperatively recorded from DBS leads comprising four individual electrodes immediately after bilateral awake implantation into the subthalamic nucleus of 21 patients with Parkinson's disease (42 hemispheres) and after subsequent GA induction deep enough to perform pulse generator implantation. The main anesthetic agent was either propofol (10 patients) or sevoflurane (11 patients). GA reduced the amplitude of ERNA, beta, and HFO activity (p < 0.001); however, ERNA amplitudes remained large in comparison to spontaneous local field potentials. Notably, a moderately strong correlation between awake ERNA amplitude and electrode distance to an "ideal" therapeutic target within dorsal STN was preserved under GA (awake: ρ = -0.73, adjusted p value [padj] < 0.001; GA: ρ = -0.69, padj < 0.001). In contrast, correlations were diminished under GA for beta (awake: ρ = -0.45, padj < 0.001; GA: ρ = -0.13, padj = 0.12) and HFO (awake: ρ = -0.69, padj < 0.001; GA: ρ = -0.33, padj < 0.001). The largest ERNA occurred at the same electrode (awake vs GA) for 35/42 hemispheres (83.3%) and corresponded closely to the electrode selected by the clinician for chronic therapy at 12 months (awake ERNA 77.5%, GA ERNA 82.5%). The largest beta amplitude occurred at the same electrode (awake vs GA) for only 17/42 (40.5%) hemispheres and 21/42 (50%) for HFO. The electrode measuring the largest awake beta and HFO amplitudes corresponded to the electrode selected by the clinician for chronic therapy at 12 months in 60% and 70% of hemispheres, respectively. However, this correspondence diminished substantially under GA (beta 20%, HFO 35%). ERNA is a robust electrophysiological signal localized to the dorsal subthalamic nucleus subregion that is largely preserved under GA, indicating it could feasibly guide electrode implantation, either alone or in complementary use with existing methods.
URI: https://ahro.austin.org.au/austinjspui/handle/1/28327
DOI: 10.3171/2021.8.JNS204225
Journal: Journal of Neurosurgery
PubMed URL: 34891136
PubMed URL: https://pubmed.ncbi.nlm.nih.gov/34891136/
Type: Journal Article
Subjects: beta
deep brain stimulation
evoked resonant neural activity
functional neurosurgery
general anesthesia
high-frequency oscillations
subthalamic nucleus
Appears in Collections:Journal articles

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