Deep brain stimulation surgery under general anesthesia in patients with Parkinson’s disease: a retrospective study in Korea

Objective: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is conventionally performed under local anesthesia to preserve intraoperative microelectrode recording (MER) quality. However, awake surgery poses challenges for Parkinson’s disease (PD) patients with severe anxiety, respiratory compromise, or debilitating “off-medication” dystonia. This study evaluated the clinical efficacy and surgical feasibility of bilateral STN-DBS under general anesthesia.Methods: We retrospectively analyzed 29 advanced PD patients who underwent bilateral STN-DBS under general anesthesia. Thirteen patients underwent a two-stage operation (Activa implantable pulse generator [IPG]), and 16 underwent a one-stage procedure (directional leads, Percept PC IPG). Target localization relied on high-resolution magnetic resonance imaging and computed tomography (CT). Intraoperative MER was performed under inhalational anesthesia with sevoflurane (n=27) or desflurane (n=2). Outcomes were assessed after ≥6 months using the Unified Parkinson’s Disease Rating Scale (UPDRS) parts III and IV and the levodopa-equivalent daily dose (LEDD).Results: Intraoperative MER successfully identified STN and substantia nigra pars reticulata boundaries in all 29 patients. Sevoflurane enabled clearer MER signal acquisition than desflurane. Mean operative times were 167.1 minutes (two-stage) and 280.1 minutes (one-stage, including intraoperative CT and IPG insertion). Postoperatively, mean UPDRS part III scores decreased significantly from 18.8±7.4 to 14.7±6.4, and part IV scores improved from 11.7±4.6 to 4.5±2.6. Mean LEDD decreased from 779.4±341.2 mg/day to 445.6±294.5 mg/day. No complications occurred.Conclusion: STN-DBS under general anesthesia is a safe, feasible, and effective alternative for advanced PD patients unable to tolerate awake surgery. Intraoperative MER remains reliable under sevoflurane anesthesia, ensuring precise electrode placement and significant clinical improvements.