{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T13:06:52Z","timestamp":1783775212366,"version":"3.55.0"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Ventral intermediate nucleus deep brain stimulation (DBS) for essential tremor is traditionally performed with intraoperative test stimulation and conscious sedation, without general anesthesia (GA). Recently, the authors reported retrospective data on 17 patients undergoing DBS after induction of GA with standardized anatomical coordinates on T1-weighted MRI sequences used for indirect targeting. Here, they compare prospectively collected data from essential tremor patients undergoing DBS both with GA and without GA (non-GA).<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Clinical outcomes were prospectively collected at baseline and 3-month follow-up for patients undergoing DBS surgery performed by a single surgeon. Stereotactic, euclidean, and radial errors of lead placement were calculated. Functional (activities of daily living), quality of life (Quality of Life in Essential Tremor [QUEST] questionnaire), and tremor severity outcomes were compared between groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Fifty-six patients underwent surgery: 16 without GA (24 electrodes) and 40 with GA (66 electrodes). The mean baseline functional scores and QUEST summary indices were not different between groups (p = 0.91 and p = 0.59, respectively). Non-GA and GA groups did not differ significantly regarding mean postoperative percentages of functional improvement (non-GA, 47.9% vs GA, 48.1%; p = 0.96) or QUEST summary indices (non-GA, 79.9% vs GA, 74.8%; p = 0.50). Accuracy was comparable between groups (mean radial error 0.9 \u00b1 0.3 mm for non-GA and 0.9 \u00b1 0.4 mm for GA patients) (p = 0.75). The mean euclidean error was also similar between groups (non-GA, 1.1 \u00b1 0.6 mm vs GA, 1.2 \u00b1 0.5 mm; p = 0.92). No patient had an intraoperative complication, and the number of postoperative complications was not different between groups (non-GA, n = 1 vs GA, n = 10; p = 0.16).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>DBS performed with the patient under GA to treat essential tremor is as safe and effective as traditional DBS surgery with intraoperative test stimulation while the patient is under conscious sedation without GA.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2017.3.jns162487","type":"journal-article","created":{"date-parts":[[2017,10,13]],"date-time":"2017-10-13T13:59:19Z","timestamp":1507903159000},"page":"290-298","source":"Crossref","is-referenced-by-count":31,"title":["Intraoperative test stimulation versus stereotactic accuracy as a surgical end point: a comparison of essential tremor outcomes after ventral intermediate nucleus deep brain stimulation"],"prefix":"10.3171","volume":"129","author":[{"given":"Tsinsue","family":"Chen","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaman","family":"Mirzadeh","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina M.","family":"Chapple","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Lambert","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virgilio G. H.","family":"Evidente","sequence":"additional","affiliation":[{"name":"Department of Neurology, Movement Disorders Center of Arizona, Scottsdale, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo","family":"Moguel-Cobos","sequence":"additional","affiliation":[{"name":"Neurology, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srivadee","family":"Oravivattanakul","sequence":"additional","affiliation":[{"name":"Neurology, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Padma","family":"Mahant","sequence":"additional","affiliation":[{"name":"Neurology, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco A.","family":"Ponce","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Mov Disord","doi-asserted-by":"publisher","first-page":"1347","DOI":"10.1002\/mds.25068","article-title":"Microelectrode recording during deep brain stimulation and ablative procedures","volume":"27","author":"Alterman RL","year":"2012","unstructured":"Alterman RL, Weisz D: Microelectrode recording during deep brain stimulation and ablative procedures. Mov Disord 27:1347\u20131349, 201210.1002\/mds.2506822927124"},{"key":"b2","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"1497","DOI":"10.1007\/s00701-014-2103-z","article-title":"The variability of atlas-based targets in relation to surrounding major fibre tracts in thalamic deep brain stimulation","volume":"156","author":"Anthofer J","year":"2014","unstructured":"Anthofer J, Steib K, Fellner C, Lange M, Brawanski A, Schlaier J: The variability of atlas-based targets in relation to surrounding major fibre tracts in thalamic deep brain stimulation. Acta Neurochir (Wien) 156:1497\u20131504, 201410.1007\/s00701-014-2103-z24829155"},{"key":"b3","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"868","DOI":"10.1136\/jnnp.56.8.868","article-title":"Assessing tremor severity","volume":"56","author":"Bain PG","year":"1993","unstructured":"Bain PG, Findley LJ, Atchison P, Behari M, Vidailhet M, Gresty M, : Assessing tremor severity. J Neurol Neurosurg Psychiatry 56:868\u2013873, 1993835010210.1136\/jnnp.56.8.868"},{"key":"b4","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1136\/jnnp-2013-304943","article-title":"The safety and efficacy of thalamic deep brain stimulation in essential tremor: 10 years and beyond","volume":"85","author":"Baizabal-Carvallo JF","year":"2014","unstructured":"Baizabal-Carvallo JF, Kagnoff MN, Jimenez-Shahed J, Fekete R, Jankovic J: The safety and efficacy of thalamic deep brain stimulation in essential tremor: 10 years and beyond. J Neurol Neurosurg Psychiatry 85:567\u2013572, 201410.1136\/jnnp-2013-30494324096713"},{"key":"b5","series-title":"Lancet Neurol","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/S1474-4422(08)70291-6","article-title":"Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson\u2019s disease","volume":"8","author":"Benabid AL","year":"2009","unstructured":"Benabid AL, Chabardes S, Mitrofanis J, Pollak P: Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson\u2019s disease. Lancet Neurol 8:67\u201381, 20091908151610.1016\/S1474-4422(08)70291-6"},{"key":"b6","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"301","DOI":"10.3171\/2013.4.JNS122324","article-title":"Accuracy of deep brain stimulation electrode placement using intraoperative computed tomography without microelectrode recording","volume":"119","author":"Burchiel KJ","year":"2013","unstructured":"Burchiel KJ, McCartney S, Lee A, Raslan AM: Accuracy of deep brain stimulation electrode placement using intraoperative computed tomography without microelectrode recording. J Neurosurg 119:301\u2013306, 20132372498610.3171\/2013.4.JNS122324"},{"key":"b7","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1842","DOI":"10.3171\/2015.6.JNS15526","article-title":"\u201cAsleep\u201d deep brain stimulation for essential tremor","volume":"124","author":"Chen T","year":"2016","unstructured":"Chen T, Mirzadeh Z, Chapple K, Lambert M, Dhall R, Ponce FA: \u201cAsleep\u201d deep brain stimulation for essential tremor. J Neurosurg 124:1842\u20131849, 20162661317710.3171\/2015.6.JNS15526"},{"key":"b8","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"360","DOI":"10.3171\/2016.6.JNS152946","article-title":"Complication rates, lengths of stay, and readmission rates in \u201cawake\u201d and \u201casleep\u201d deep brain simulation","volume":"127","author":"Chen T","year":"2017","unstructured":"Chen T, Mirzadeh Z, Chapple K, Lambert M, Ponce FA: Complication rates, lengths of stay, and readmission rates in \u201cawake\u201d and \u201casleep\u201d deep brain simulation. J Neurosurg 127:360\u2013369, 201710.3171\/2016.6.JNS152946"},{"key":"b9","series-title":"Neuropsychiatr Dis Treat","doi-asserted-by":"publisher","first-page":"1859","DOI":"10.2147\/NDT.S32342","article-title":"Current clinical application of deep-brain stimulation for essential tremor","volume":"9","author":"Chopra A","year":"2013","unstructured":"Chopra A, Klassen BT, Stead M: Current clinical application of deep-brain stimulation for essential tremor. Neuropsychiatr Dis Treat 9:1859\u20131865, 20132432433510.2147\/NDT.S32342"},{"key":"b10","doi-asserted-by":"publisher","DOI":"10.5334\/tohm.131","article-title":"Tremor","author":"Elbe RJ","year":"1990","unstructured":"Elbe RJ, Koller WC: Tremor. Baltimore: John Hopkins University Press, 199010.5334\/tohm.131"},{"key":"b11","series-title":"Mov Disord","doi-asserted-by":"publisher","first-page":"1793","DOI":"10.1002\/mds.25648","article-title":"Task force report: scales for screening and evaluating tremor: critique and recommendations","volume":"28","author":"Elble R","year":"2013","unstructured":"Elble R, Bain P, Forjaz MJ, Haubenberger D, Testa C, Goetz CG, : Task force report: scales for screening and evaluating tremor: critique and recommendations. Mov Disord 28:1793\u20131800, 20132403857610.1002\/mds.25648"},{"key":"b12","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"132","DOI":"10.3171\/2013.10.JNS131225","article-title":"Risks of common complications in deep brain stimulation surgery: management and avoidance","volume":"120","author":"Fenoy AJ","year":"2014","unstructured":"Fenoy AJ, Simpson RK Jr: Risks of common complications in deep brain stimulation surgery: management and avoidance. J Neurosurg 120:132\u2013139, 20142423665710.3171\/2013.10.JNS131225"},{"key":"b13","series-title":"J Neurol","doi-asserted-by":"publisher","first-page":"1643","DOI":"10.1007\/s00415-011-5986-0","article-title":"Steady or not following thalamic deep brain stimulation for essential tremor","volume":"258","author":"Hwynn N","year":"2011","unstructured":"Hwynn N, Hass CJ, Zeilman P, Romrell J, Dai Y, Wu SS, : Steady or not following thalamic deep brain stimulation for essential tremor. J Neurol 258:1643\u20131648, 201110.1007\/s00415-011-5986-021442464"},{"key":"b14","series-title":"Crit Rev Biomed Eng","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1615\/CritRevBiomedEng.v35.i5.10","article-title":"A review on techniques for tremor recording and quantification","volume":"35","author":"Mansur PH","year":"2007","unstructured":"Mansur PH, Cury LK, Andrade AO, Pereira AA, Miotto GA, Soares AB, : A review on techniques for tremor recording and quantification. Crit Rev Biomed Eng 35:343\u2013362, 20071939264210.1615\/CritRevBiomedEng.v35.i5.10"},{"key":"b15","series-title":"Mov Disord","doi-asserted-by":"publisher","first-page":"1788","DOI":"10.1002\/mds.26056","article-title":"Validation of CT-MRI fusion for intraoperative assessment of stereotactic accuracy in DBS surgery","volume":"29","author":"Mirzadeh Z","year":"2014","unstructured":"Mirzadeh Z, Chapple K, Lambert M, Dhall R, Ponce FA: Validation of CT-MRI fusion for intraoperative assessment of stereotactic accuracy in DBS surgery. Mov Disord 29:1788\u20131795, 20142537721310.1002\/mds.26056"},{"key":"b16","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"902","DOI":"10.3171\/2015.4.JNS1550","article-title":"Parkinson\u2019s disease outcomes after intraoperative CT-guided \u201casleep\u201d deep brain stimulation in the globus pallidus internus","volume":"124","author":"Mirzadeh Z","year":"2016","unstructured":"Mirzadeh Z, Chapple K, Lambert M, Evidente VG, Mahant P, Ospina MC, : Parkinson\u2019s disease outcomes after intraoperative CT-guided \u201casleep\u201d deep brain stimulation in the globus pallidus internus. J Neurosurg 124:902\u2013907, 201610.3171\/2015.4.JNS155026452116"},{"key":"b17","series-title":"Mov Disord","doi-asserted-by":"publisher","first-page":"1387","DOI":"10.1002\/mds.25000","article-title":"Microelectrode targeting of the subthalamic nucleus for deep brain stimulation surgery","volume":"27","author":"Montgomery EB Jr","year":"2012","unstructured":"Montgomery EB Jr: Microelectrode targeting of the subthalamic nucleus for deep brain stimulation surgery. Mov Disord 27:1387\u20131391, 201210.1002\/mds.2500022508394"},{"key":"b18","series-title":"Stereotact Funct Neurosurg","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1159\/000330379","article-title":"MRI-guided subthalamic nucleus deep brain stimulation without microelectrode recording: can we dispense with surgery under local anaesthesia?","volume":"89","author":"Nakajima T","year":"2011","unstructured":"Nakajima T, Zrinzo L, Foltynie T, Olmos IA, Taylor C, Hariz MI, : MRI-guided subthalamic nucleus deep brain stimulation without microelectrode recording: can we dispense with surgery under local anaesthesia? Stereotact Funct Neurosurg 89:318\u2013325, 20112192167310.1159\/000330379"},{"key":"b19","series-title":"Clin Neurol Neurosurg","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1016\/j.clineuro.2012.08.019","article-title":"Clinical outcomes of PD patients having bilateral STN DBS using high-field interventional MR-imaging for lead placement","volume":"115","author":"Ostrem JL","year":"2013","unstructured":"Ostrem JL, Galifianakis NB, Markun LC, Grace JK, Martin AJ, Starr PA, : Clinical outcomes of PD patients having bilateral STN DBS using high-field interventional MR-imaging for lead placement. Clin Neurol Neurosurg 115:708\u2013712, 201310.1016\/j.clineuro.2012.08.01922944465"},{"key":"b20","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"506","DOI":"10.3171\/jns.2006.104.4.506","article-title":"Long-term evaluation of deep brain stimulation of the thalamus","volume":"104","author":"Pahwa R","year":"2006","unstructured":"Pahwa R, Lyons KE, Wilkinson SB, Simpson RK Jr, Ondo WG, Tarsy D, : Long-term evaluation of deep brain stimulation of the thalamus. J Neurosurg 104:506\u2013512, 200610.3171\/jns.2006.104.4.50616619653"},{"issue":"Suppl 2","key":"b21","series-title":"Neurosurgery","first-page":"190","article-title":"Adverse events associated with deep brain stimulation for movement disorders: analysis of 510 consecutive cases","volume":"11","author":"Patel DM","year":"2015","unstructured":"Patel DM, Walker HC, Brooks R, Omar N, Ditty B, Guthrie BL: Adverse events associated with deep brain stimulation for movement disorders: analysis of 510 consecutive cases. Neurosurgery 11 (Suppl 2):190\u2013199, 201525599204"},{"issue":"Suppl 1","key":"b22","series-title":"Parkinsonism Relat Disord","first-page":"S171","article-title":"Recent advances in essential tremor: Surgical treatment","volume":"22","author":"Picillo M","year":"2016","unstructured":"Picillo M, Fasano A: Recent advances in essential tremor: Surgical treatment. Parkinsonism Relat Disord 22 (Suppl 1):S171\u2013S175, 2016"},{"key":"b23","series-title":"Stereotact Funct Neurosurg","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1159\/000442425","article-title":"Awake neurophysiologically guided versus asleep MRI-guided STN DBS for Parkinson disease: a comparison of outcomes using levodopa equivalents","volume":"93","author":"Saleh S","year":"2015","unstructured":"Saleh S, Swanson KI, Lake WB, Sillay KA: Awake neurophysiologically guided versus asleep MRI-guided STN DBS for Parkinson disease: a comparison of outcomes using levodopa equivalents. Stereotact Funct Neurosurg 93:419\u2013426, 20152678445510.1159\/000442425"},{"key":"b24","article-title":"Atlas for Stereotaxy of the Human Brain","author":"Schaltenbrand G","year":"1977","unstructured":"Schaltenbrand G, Wahren W: Atlas for Stereotaxy of the Human Brain, ed 2. Stuttgart: Thieme, 1977"},{"key":"b25","series-title":"Neuromodulation","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1111\/ner.12238","article-title":"Deep brain stimulation for essential tremor: targeting the dentato-rubro-thalamic tract?","volume":"18","author":"Schlaier J","year":"2015","unstructured":"Schlaier J, Anthofer J, Steib K, Fellner C, Rothenfusser E, Brawanski A, : Deep brain stimulation for essential tremor: targeting the dentato-rubro-thalamic tract? Neuromodulation 18:105\u2013112, 201510.1111\/ner.1223825209587"},{"key":"b26","series-title":"J Neurol","doi-asserted-by":"publisher","first-page":"1226","DOI":"10.1007\/s00415-016-8125-0","article-title":"Intraoperative MRI for deep brain stimulation lead placement in Parkinson\u2019s disease: 1 year motor and neuropsychological outcomes","volume":"263","author":"Sidiropoulos C","year":"2016","unstructured":"Sidiropoulos C, Rammo R, Merker B, Mahajan A, LeWitt P, Kaminski P, : Intraoperative MRI for deep brain stimulation lead placement in Parkinson\u2019s disease: 1 year motor and neuropsychological outcomes. J Neurol 263:1226\u20131231, 20162712645710.1007\/s00415-016-8125-0"},{"key":"b27","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"479","DOI":"10.3171\/2009.6.JNS081161","article-title":"Subthalamic nucleus deep brain stimulator placement using high-field interventional magnetic resonance imaging and a skull-mounted aiming device: technique and application accuracy","volume":"112","author":"Starr PA","year":"2010","unstructured":"Starr PA, Martin AJ, Ostrem JL, Talke P, Levesque N, Larson PS: Subthalamic nucleus deep brain stimulator placement using high-field interventional magnetic resonance imaging and a skull-mounted aiming device: technique and application accuracy. J Neurosurg 112:479\u2013490, 201010.3171\/2009.6.JNS081161"},{"key":"b28","series-title":"Parkinsonism Relat Disord","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1016\/j.parkreldis.2005.05.009","article-title":"Quality of life in Essential Tremor Questionnaire (QUEST): development and initial validation","volume":"11","author":"Tr\u00f6ster AI","year":"2005","unstructured":"Tr\u00f6ster AI, Pahwa R, Fields JA, Tanner CM, Lyons KE: Quality of life in Essential Tremor Questionnaire (QUEST): development and initial validation. Parkinsonism Relat Disord 11:367\u2013373, 200510.1016\/j.parkreldis.2005.05.00916103000"},{"key":"b29","series-title":"Tremor Other Hyperkinet Mov (N Y)","first-page":"3","article-title":"Quantitative methods for evaluating the efficacy of thalamic deep brain stimulation in patients with essential tremor","volume":"3","author":"Wastensson G","year":"2013","unstructured":"Wastensson G, Holmberg B, Johnels B, Barregard L: Quantitative methods for evaluating the efficacy of thalamic deep brain stimulation in patients with essential tremor. Tremor Other Hyperkinet Mov (N Y) 3:3, 2013"},{"key":"b30","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1271","DOI":"10.3171\/2009.10.JNS09371","article-title":"Long-term results of thalamic deep brain stimulation for essential tremor","volume":"112","author":"Zhang K","year":"2010","unstructured":"Zhang K, Bhatia S, Oh MY, Cohen D, Angle C, Whiting D: Long-term results of thalamic deep brain stimulation for essential tremor. J Neurosurg 112:1271\u20131276, 201010.3171\/2009.10.JNS0937119911883"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/129\/2\/article-p290.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/129\/2\/article-p290.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/129\/2\/article-p290.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T02:52:57Z","timestamp":1743389577000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/129\/2\/article-p290.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8]]},"references-count":30,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2017.3.jns162487","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,8]]}}}