Asleep Deep Brain Stimulation for Essential Tremor

Introduction: Deep Brain Stimulation (DBS) was approved for Essential Tremor by the Food and Drug Administration (FDA) in 1997. Since that time, technological advancements in implanted hardware and operative technique have changed the landscape of functional neurosurgery. Interventional MRI-guided DBS lead placement is an emerging technique that can be used to treat ET patients, though the data is limited due to the perceived difficulty of direct targeting the ventral intermediate nucleus (VIM) relative to other structures. Here we review the experience of a single surgeon with interventional MRI guided DBS targeting of the VIM in ET patients under general anesthesia in a community setting. Method: We conducted a retrospective chart review of ET patients who underwent DBS under general anesthesia using an MRI-guided ClearPoint surgical technique at Willis-Knighton Health System between 2016 and 2021. Demographics, radial error, procedure details, complications, and clinical outcomes were collected. Clinical outcome measures included medication reduction postoperatively, the Quality of Life in Essential Tremor Questionnaire (QUEST), and the Fahn-Tolsa-Marin tremor rating scale (FTM). Results: A total of 113 ET patients underwent placement of 175 DBS leads. The 2D Radial Error on the was 0.43 ± 0.33 mm with only 2 leads requiring more than one pass. Following DBS placement, 69.2% stopped or reduced medication. There was an average reduction of 76.4% in total FTM score with a mean pre-operative FTM score of 34 and a post-operative FTM score of 8.9 (p <0.001). The QUEST Summary index improved from 47.1 preoperatively to 29.4 post-operatively with an average improvement of 77.8%. Conclusion: Interventional MRI-guided DBS lead placement under general anesthesia is a feasible and effective technique for ET patients that may expand the reach of DBS therapy to patients with advanced age, comorbidities, and/or anxiety regarding traditional, awake surgery.