Comparison And Result Analysis Of Robotic DBS Surgery Under General Anesthesia And Frame DBS Surgery Under Local Anesthesia

Background and Objective:Parkinson’s disease（PD）is a neurodegenerative disease in which patients take levodopa orally in the early stages to control their symptoms.However,with the progress of the disease,the dosage of oral drugs for Parkinson’s disease gradually increases,and the side effects of oral drugs gradually increase.In the middle and late stages of Parkinson’s disease,surgical treatment becomes an important choice for Parkinson’s disease.Deep brain stimulation（DBS）is currently the most commonly used surgical procedure for Parkinson’s disease.Traditional DBS surgery is performed after localization of specific intracranial nuclei by stereotactic head brace under local anesthesia.With the development of medicine,neurosurgical robots have been gradually applied in clinical practice,and some medical institutions have adopted localization of surgical robots under general anesthesia for DBS surgery.Our unit has performed a certain number of DBS operations using the above two methods.This study aims to investigate whether robotic DBS surgery under general anesthesia can achieve similar surgical effects to stereoscopic head-frame DBS surgery under local anesthesia by comparing the data collected from the two different surgical methods,such as surgical accuracy,operation time and postoperative efficacy.It provides some reference significance for the future application of neurosurgical robot in functional neurosurgery.Methods:The clinical data of 44 patients who underwent DBS surgery in ChinaJapan Union Hospital of Jilin University from June 2018 to October 2021 were retrospectively analyzed.All patients met the PD diagnostic criteria of the International Society of Movement Disorders in 2015,and were evaluated by movement disorders specialists in the Department of Neurology.Patients eligible for surgery were transferred to the neurosurgery department for DBS surgery.All patients underwent The Movement Disordered Society-sponsored Revision of The Unified Parkinson’s disease Rating before surgery Scale III（MDS-UPDRSIII）was used to assess patients’ ability to exercise,and the Quality of life of patients was evaluated by the Parkinson’s disease Questionnaire（PDQ-39）.According to different surgical methods,all patients were divided into stereotactic frame DBS surgery group under local anesthesia and robot DBS surgery group under general anesthesia.The operative time,postoperative intracranial gas volume and surgical target error were reviewed.Pulse generator（IPG）was turned on one month after surgery,and deep brain stimulation was started.Unified UPDRSIII and PDQ-39 scores were performed.Finally,T test and rank-sum test were used to compare the operative time,postoperative intracranial gas volume,surgical target error and the improvement rate of UPDRSIII and PDQ-39 before and after surgery,so as to analyze the differences between the two surgical methods.Results:Twenty-two of the 44 patients underwent surgery using a stereotactic head frame under local anesthesia.Twenty-two patients were operated by neurosurgical robot under general anesthesia.There was no statistical difference in age,gender,course of disease,preoperative UPDRSIII score,PDQ-39 score and other indicators between the two groups.Preoperative data of the two groups were consistent with homogeneity.According to statistics,the operation time of the robot group under general anesthesia was shorter than that of the stereotactic head frame operation group under local anesthesia,and there was statistical significance.In terms of surgical accuracy,the target error of the robot surgery group under general anesthesia was less than that of the stereotactic head frame surgery group under local anesthesia,and there was statistical significance.The improvement rate of PDQ-39 in the robot surgery group under general anesthesia was significantly higher than that in the stereotactic head frame surgery group under local anesthesia.There was no statistical difference in intracranial gas volume and UPDRSIII improvement rate one month after operation.Conclusion:1.DBS surgery has a clear therapeutic effect on advanced Parkinson’s disease.2.We through comparing the DBS surgery under local anesthesia stereotactic head frame and the robot DBS surgery under general anesthesia clinical data,can be obtained under the general anesthesia surgery robot DBS and classic DBS surgery under local anesthesia stereotactic head frame the same curative effect,and the precision,the operation time and PDQ-39 score more advantages in short period.