Evaluation of Patient Perspectives Toward Awake, Frame-Based Deep-Brain Stimulation Surgery

• Published in: World neurosurgery 2018-03, Vol.111, p.e601-e607
• Main Authors: Ben-Haim, Sharona, Falowski, Steven M.
• Format: Article
• Language: English
• Subjects: Deep-brain stimulation; Essential tremor; Frame-based stereotaxy; Movement disorders; Parkinson disease
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.12.122

Deep brain stimulation (DBS) is an effective therapeutic modality; however, only a percentage of eligible patients undergo the procedure. To study patients' perspectives toward DBS surgery. A survey was sent to 95 consecutive adult patients who underwent DBS surgery for Parkinson disease, essential tremor, or dystonia; the response rate was 73% (69 patients). Post-hoc analyses were performed to evaluate factors that led to favorable outcomes. The average time between surgical procedure to survey completion was 16 months. Awake surgery, use of a rigid head frame, and having hair clipped were seldom reported as major deterrents to surgery. Patients retrospectively reported an average comfort level of 8.3 ± 1.8 during surgery. The average comfort level with head frame placement was reported as 5.2 ± 3.15, and patients reporting discomfort with the frame nonetheless reported overall comfort with the procedure (8.7 ± 1.8). An analysis of satisfaction revealed that 90% of patients would recommend the procedure to a family member or friend and that 78% of patients would undergo the procedure again. A post-hoc analysis of patients who were not satisfied with the procedure revealed that this subset reported significantly less overall comfort (6.9 ± 1.7, P = 0.0003) and were less likely to report that the goals and expectations of surgery were clearly discussed before surgery (P = 0.0004). Frame placement, awake surgery, and head shaving did not appear to play a significant role in most patients' decision-making process to undergo DBS, as analyzed in this retrospective cohort. The majority of patients were satisfied with the procedure and reported being comfortable. Managing goals and expectations preoperatively played a significant role in ultimate overall satisfaction.