Choice of anesthesia in microelectrode recording-guided deep brain stimulation surgery for Parkinson's disease (CHAMPION): A noninferiority randomized controlled trial.
Summary
In 188 patients, desflurane-titrated general anesthesia was noninferior to dexmedetomidine-based conscious sedation for achieving high-quality MER (89.4% vs 90.3%). General anesthesia reduced operative time by about 9 minutes with similar 6-month motor outcomes and complications, supporting GA as a valid option for MER-guided STN-DBS.
Key Findings
- High-quality MER proportion: GA 89.4% vs CS 90.3%; noninferior (difference −0.96%; 95% CI −9.62 to 7.70).
- Operative time was shorter with GA (−9.07 minutes; 95% CI −13.99 to −4.14; P<0.001).
- Six-month UPDRS change, LEDD reduction, and complication rates were comparable between groups.
Clinical Implications
General anesthesia with carefully titrated desflurane is a defensible standard approach for STN-DBS with MER, offering workflow efficiency without compromising signal quality or 6-month outcomes.
Why It Matters
This high-quality RCT addresses a long-standing controversy on anesthesia choice for MER-guided DBS, showing that GA can preserve electrophysiologic signal quality while improving efficiency.
Limitations
- Single-agent frameworks (desflurane and dexmedetomidine) may limit generalizability to other agents.
- Conducted in experienced centers; external validity to low-volume programs requires caution.
Future Directions
Evaluate GA strategies with other anesthetics and sedation regimens, assess longer-term outcomes and cognitive effects, and test scalability across varied DBS programs.
Study Information
- Study Type
- RCT
- Research Domain
- Treatment
- Evidence Level
- I - Randomized controlled trial providing high-level comparative evidence.
- Study Design
- OTHER