Asleep Deep Brain Stimulation Reduces Incidence of Intracranial Air during Electrode Implantation

Andrew L. Ko, Philippe Magown, Alp Ozpinar, Vural Hamzaoglu, Kim J. Burchiel

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Background: Asleep deep brain stimulation (aDBS) implantation replaces microelectrode recording for image-guided implantation, shortening the operative time and reducing cerebrospinal fluid egress. This may decrease pneumocephalus, thus decreasing brain shift during implantation. Objective: To compare the incidence and volume of pneumocephalus during awake (wkDBS) and aDBS procedures. Methods: A retrospective review of bilateral DBS cases performed at Oregon Health & Science University from 2009 to 2017 was undertaken. Postimplantation imaging was reviewed to determine the presence and volume of intracranial air and measure cortical brain shift. Results: Among 371 patients, pneumocephalus was noted in 66% of wkDBS and 15.6% of aDBS. The average volume of air was significantly higher in wkDBS than aDBS (8.0 vs. 1.8 mL). Volumes of air greater than 7 mL, which have previously been linked to brain shift, occurred significantly more frequently in wkDBS than aDBS (34 vs 5.6%). wkDBS resulted in significantly larger cortical brain shifts (5.8 vs. 1.2 mm). Conclusions: We show that aDBS reduces the incidence of intracranial air, larger air volumes, and cortical brain shift. Large volumes of intracranial air have been correlated to shifting of brain structures during DBS procedures, a variable that could impact accuracy of electrode placement.

Original languageEnglish (US)
Pages (from-to)83-90
Number of pages8
JournalStereotactic and Functional Neurosurgery
Issue number2
StatePublished - Jun 1 2018


  • Asleep deep brain stimulation
  • Brain shift
  • Deep brain stimulation
  • Pneumocephalus
  • Stereotactic error

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


Dive into the research topics of 'Asleep Deep Brain Stimulation Reduces Incidence of Intracranial Air during Electrode Implantation'. Together they form a unique fingerprint.

Cite this