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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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How to minimise complications in deep brain stimulation – technical considerations in a series of 240 DBS procedures

Minimierung von Komplikationen bei Tiefer Hirnstimulation – methodische Aspekte in einer Serie von 240 THS-Operationen

Meeting Abstract

Suche in Medline nach

  • presenting/speaker Cordula Matthies - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Robert Nickl - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Philipp Capetian - Universitätsklinikum Würzburg, Neurologische Klinik und Poliklinik, Würzburg, Deutschland
  • Jens Volkmann - Universitätsklinikum Würzburg, Neurologische Klinik und Poliklinik, Würzburg, Deutschland
  • Ralf-Ingo Ernestus - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Frank Steigerwald - Universitätsklinikum Würzburg, Neurologische Klinik und Poliklinik, Würzburg, Deutschland
  • Patrick Fricke - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV014

doi: 10.3205/19dgnc014, urn:nbn:de:0183-19dgnc0149

Veröffentlicht: 8. Mai 2019

© 2019 Matthies et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objective: DBS may improve quality of life in advanced movement disorders, but bears a significant risk of early and late complications such as hemorrhage, infection and material extrusion. Each surgical step needs close consideration in an intent to minimize any possible sequels.

Methods: In a prospectively collected series of 240 DBS procedures (152 for Parkinson’s disease, 49 for dystonia, 34 for essential tremor, 5 for rare indications) we applied special techniques in skin approach, burr hole closure, electrode fixation, placing of extensions, trajectory and target planning, micro-electrode selection and modification aiming for minimal complications early (post-surgical in-clinic phase) and long-term (minimum follow-up of one year).

Results: In 240 consecutive interventions, 473 electrodes (233 bilateral, 7 unilateral) were implanted after an average of 2 to 3 micro-electrodes for micro-recording and semi-macro-stimulation test applications. Early complications included one intra-operative epidural hematoma, single epileptic fits in 3 patients, no intracerebral hemorrhage (0.0%), no infection (0.0%). An idiopathic delayed onset edema was documented in 9 patients, temporary confusion in 10 PD patients. In 10 patients (0.4%), lead revision was performed because of insufficient stimulation effect (8 patients) or upward lead dislocation (2 patients). Long-term, two patients suffered skin lesions from repeated falls and needed material explantation and re-implantation. One late electrode dislocation after 5 years after repeated falls was treated by successful stereotactic re-positioning.

Conclusion: Careful consideration and optimization of each step of surgical planning and performance enable a significant reduction of morbidity in DBS. Certain biological phenomena such as idiopathic edema need further observation and investigation. Reliable interdisciplinary cooperation and careful patient evaluation early and long-term are milestones for long-term quality in DBS treatment