According to PhD student Saman Vinke of Radboudumc in Nijmegen, brain surgery in people with Parkinson’s disease that requires the patient to stay awake can also be done under anesthesia.
During deep brain stimulation surgery for Parkinson’s disease, the patient is usually awake so doctors can test whether the electrode is placed correctly. Not necessary, according to the thesis of neurosurgeon Saman Vinke of Radboud university medical center.
An MRI scan makes measurements and tests during the operation superfluous. As a result, the operation can be performed under anesthesia and it is possible to perform two operations per day instead of one. The anesthesia mainly convinces women with Parkinson’s, who opt less often for an operation in an awake state.
Parkinson’s symptoms
The brain surgery can help against tremors, slowness and stiffness, known symptoms of Parkinson’s disease. This is done with small electrical impulses in the brain, so-called deep brain stimulation (DBS). To do this, a neurosurgeon places two electrodes in a deep part of the brain through holes in the skull. Via a pacemaker, the electrodes give electrical impulses, which can greatly reduce the complaints. In the Netherlands, this involves three hundred procedures per year.
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In the classic surgical method, the patient is largely awake. ‘This method is thirty years old,’ says neurosurgeon Saman Vinke. ‘The surgeon uses small currents to find the right place for the electrodes. Thanks to the awake state, the surgeon can immediately check whether the symptoms are improving.’ But there are drawbacks to this classic method. For example, the operation takes almost an entire working day, most of which the patient is awake with the head fixed. In addition, the patient has to temporarily stop taking medication, which makes the complaints worse.
New method
Vinke has examined whether an MRI scan can just as well find the right place in the brain. This makes the procedure shorter and patients can continue to take their medication. For the study, 123 patients underwent surgery, some in an awake state and some under anesthesia. To verify the conclusions, data from about 650 patients from abroad were also examined.
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Because the operation can be done under anesthesia if an MRI scan is used, more women are also choosing to participate. Vinke: ‘Parkinson’s occurs in 40 percent of cases in women. But in our study, only 17 percent of patients with the classical surgical method were female. Since we started operating under anesthesia, that percentage has risen to over 40 percent, just as the disease is distributed in the population.’
Vinke does not know why women opt less often for an awake operation. That is still being researched. Radboudumc now only performs deep brain stimulation operations with an MRI scan and under anesthesia.