Deep brain stimulation (DBS) is well-established, evidence-based therapy for Parkinson disease (PD), essential tremor (ET), and primary dystonia. Recent clinical outcome studies have shown that “asleep” DBS lead placement, performed using intraoperative imaging with stereotactic accuracy as the surgical endpoint, has motor outcomes comparable to traditional “awake” DBS using microelectrode recording (MER), but with shorter case times and improved speech fluency. A recent study additionally found that distinct procedural variables in DBS surgery are associated with reduced case times and improved stereotactic accuracy. Researchers conducted a retrospective review of 323 cases with 546 leads placed. In 52% (n=168) of cases, patients were asleep under general anesthesia without MER. They found:

• MER was an independent contributor to increased procedure time (+44 minutes).
• Stereotactic accuracy was better in asleep patients.
• Accuracy was improved with frame-based stereotaxy at head of bed 0° vs frameless stereotaxy at head of bed 30°.
• Improved accuracy was also associated with shorter procedures (r = 0.17).
• Vector errors were evenly distributed around the planned target for the globus pallidus internus, but directionally skewed for the subthalamic (medial-posterior) and ventral intermediate nuclei (medial-anterior).