Artikel
Surgery‐related 30-day morbidity of deep brain stimulation in a large cohort of 600 patients
30-Tage Morbidität nach tiefer Hirnstimulation an einem großen Patientenkollektiv von 600 Patienten
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Autoren
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Joachim Runge
- Medizinische Hochschule, Neurochirurgie, Hannover, Deutschland
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Assel Saryyeva
- Medizinische Hochschule Hannover, Neurochirurgie, Hannover, Deutschland
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Marc Wolf
- Universitätsklinikum, Neurologie, Mannheim, Deutschland
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Christian Blahak
- Universitätsklinikum, Neurologie, Mannheim, Deutschland
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Thomas M. Kinfe
- Universitätsklinikum, Neurochirurgie, Bonn, Deutschland
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Christoph Schrader
- Medizinische Hochschule, Neurologie, Hannover, Deutschland
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Holger H. Capelle
- Medizinische Hochschule Hannover, Neurochirurgie, Hannover, Deutschland
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Hansjörg Bäzner
- Universitätsklinikum, Neurologie, Mannheim, Deutschland
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Mahmoud Abdallat
- Medizinische Hochschule Hannover, Neurochirurgie, Hannover, Deutschland
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Joachim K. Krauss
- Medizinische Hochschule Hannover, Neurochirurgie, Hannover, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: In this retrospective study we analyzed the surgery‐ and hardware‐related morbidity of deep brain stimulation within 30 days after surgery.
Methods: 600 functional stereotactic operations (DBS electrode implantation or radiofrequency lesioning) were performed from 1997 to 2018. All procedures were performed or supervised by the senior neurosurgeon in three different centers using the same technique. The target was determined with CT-stereotactic surgery supplemented by MR imaging and approached via a guiding cannula. MER was performed in 2/3 of the cases via a single channel technique, supplemented by additional trajectories if decided necessary. Surgery was performed while patient was awake in 531 instances. Postoperative CT scans obtained within 24 hours after surgery were searched for haemorrhage of any size at any site. Hardware- or other surgery-related complications within 30 days after surgery were documented.
Results: A total of 251 women and 349 men with a median age of 55 years were operated. The majority of patients underwent DBS (580), while a subset had radiofrequency lesioning procedures (20). Overall in 19 (3.25%) procedures an intracranial haemorrhage was detected, which was asymptomatic in all patients except in 1 patient (0,16%), who had a persistent mild hemiparesis on the right side. Early infections were noticed in 3 patients (0,53%), 1 at the site of the IPG, 2 at the site of the cranial skin incision. Four patients (0,7%) had an intraoperative seizure, and 2 (0,3%) had a seizure one day after surgery. Three patients (0,53%) had clinically relevant intraoperative air embolism, and in 1 patient (0,16%) pulmonary embolism occurred. One patient (0,16%) had an acute coronary syndrome during IPG implantation, in four patients (0,7%) surgery terminated because of cardiac coronary syndromes were suspected, which however, weren’t confirmed later.
Conclusion: Stereotactic functional surgery is a generally safe procedure with low morbidity and no mortality when performed by an experienced team. Intraoperative haemorrhage constitutes the highest surgically related complication. Awake surgery is tolerated without relevant problems by the majority of patients. Infections within 30 days after surgery are rare.
