Interdisciplinary Neurosurgery (Jun 2022)
Survey of practice preferences in deep brain stimulation surgery in the United States
Abstract
Objective: Deep Brain Stimulation (DBS) is an established treatment modality for various movement disorders. There is sparse data reporting long-term efficacy and cost-effectiveness in DBS. The rapidly evolving techniques, devices and technology leads to highly variable practice patterns within the specialty. The purpose of this study is to survey the current variability in national practice patterns in DBS. Methods: We conducted an online survey to investigate various practice preferences related to the perioperative management of DBS. Variables included practice types, hardware used, timing of surgery, and postoperative management. The survey was distributed electronically to all American Association of Neurological Surgeons (AANS)-registered board-certified neurosurgeons in North America with sub-specialty training in functional and stereotactic neurosurgery. Results: We received 40 responses from 114 surveys sent via email (35.1% response rate). There was notable heterogeneity in practice preferences specific to type of anesthesia utilized with the majority of respondents using conscious sedation (62.6%) or local anesthesia (22.5%). Less than half of respondents (47.5%) used intra-operative O-arm or computed tomography (CT) to confirm electrode positioning with fewer using intra-operative magnetic resonance imaging (15%). The greatest concordance amongst respondents pertained to placement of bilateral electrodes during the same case (72.5%), performing internal pulse generator placement on a later date (80%) and obtaining a post-operative CT (77.5%). There were additional practice differences in microelectrode recording, device specific characteristics and post-operative care. Conclusion: Practice patterns in DBS vary widely and will grow more varied as new technology and devices become available. This may lead to overall increased cost and difficulty incorporating individualized technologies for patients, especially in light of hospitals’ financial structures. This study identified significant variability in anesthesia techniques, intraoperative imaging, microelectode recording, device selection and post-operative care. Understanding sources of variability in DBS may enable implementation of cost-efficient measures without compromising patient safety and outcomes.
