**Bilateral Subthalamic Nucleus Deep Brain Stimulation under General Anesthesia: Literature Review and Single Center Experience**

### **Hye Ran Park 1, Yong Hoon Lim 2, Eun Jin Song 2, Jae Meen Lee 3, Kawngwoo Park 4, Kwang Hyon Park 5, Woong-Woo Lee 6, Han-Joon Kim 7, Beomseok Jeon 7 and Sun Ha Paek 2,\***


Received: 31 August 2020; Accepted: 17 September 2020; Published: 21 September 2020

**Abstract:** Bilateral subthalamic nucleus (STN) Deep brain stimulation (DBS) is a well-established treatment in patients with Parkinson's disease (PD). Traditionally, STN DBS for PD is performed by using microelectrode recording (MER) and/or intraoperative macrostimulation under local anesthesia (LA). However, many patients cannot tolerate the long operation time under LA without medication. In addition, it cannot be even be performed on PD patients with poor physical and neurological condition. Recently, it has been reported that STN DBS under general anesthesia (GA) can be successfully performed due to the feasible MER under GA, as well as the technical advancement in direct targeting and intraoperative imaging. The authors reviewed the previously published literature on STN DBS under GA using intraoperative imaging and MER, focused on discussing the technique, clinical outcome, and the complication, as well as introducing our single-center experience. Based on the reports of previously published studies and ours, GA did not interfere with the MER signal from STN. STN DBS under GA without intraoperative stimulation shows similar or better clinical outcome without any additional complication compared to STN DBS under LA. Long-term follow-up with a large number of the patients would be necessary to validate the safety and e fficacy of STN DBS under GA.

**Keywords:** general anesthesia; intraoperative computed tomography; intraoperative magnetic resonance imaging; local anesthesia; microelectrode recording; Parkinson's disease; subthalamic nucleus; deep brain stimulation
