Comparison of General and Local Anesthesia for Deep Brain Stimulator Insertion: A Systematic Review

Area of Science:

• Neurosurgery
• Neurology
• Medical Technology

Background:

• Subthalamic nucleus deep brain stimulation (STN-DBS) is a standard Parkinson's disease (PD) treatment.
• Clinical outcomes for STN-DBS under general anesthesia (GA) versus local anesthetic (LA) are inconsistently reported.
• Heterogeneity in outcomes makes direct comparison difficult.

Purpose of the Study:

• To systematically review and meta-analyze clinical outcomes of STN-DBS under GA compared to LA in PD patients.
• To determine if GA is a viable alternative to LA for STN-DBS procedures.
• To assess postoperative symptom improvement and medication requirements.

Main Methods:

• Searched Medline, Embase, Cochrane Library, and Pubmed for eligible studies (1946-Jan 2016).
• Included six retrospective cohort studies with 455 patients (194 GA, 261 LA).
• Primary outcomes: postoperative Unified Parkinson's Disease Rating Scale (UPDRS) and levodopa equivalent dosage (LEDD).

Main Results:

• No significant differences in postoperative UPDRS scores or LEDD between GA and LA groups.
• Adverse events and target accuracy were comparable between the anesthesia groups.
• Six studies with 455 patients were included in the meta-analysis.

Conclusions:

• Current evidence lacks sufficient quality to confirm the equivalence of GA to LA for STN-DBS in PD.
• Some trends suggest potential advantages for the LA technique.
• A prospective randomized controlled trial is recommended to validate these findings.