gms | German Medical Science

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

How to reduce pneumocephalus in deep brain stimulation surgery? Analysis of potential crucial factors in a series of 100 consecutive patients

Weniger Pneumencephalus bei der Tiefen Hirnstimulation? Analyse potentieller Risikofaktoren in 100 operierten Patienten

Meeting Abstract

  • presenting/speaker Philipp Krauss - UniversitätsSpital Zürich, Klinik für Neurochirurgie, Zürich, Switzerland; UniversitätsSpital Zürich, Klinisches Neurozentrum, Zürich, Switzerland
  • Bas van Niftrik - UniversitätsSpital Zürich, Klinik für Neurochirurgie, Zürich, Switzerland; UniversitätsSpital Zürich, Klinisches Neurozentrum, Zürich, Switzerland
  • Giovanni Muscas - UniversitätsSpital Zürich, Klinik für Neurochirurgie, Zürich, Switzerland; UniversitätsSpital Zürich, Klinisches Neurozentrum, Zürich, Switzerland
  • Markus F. Oertel - UniversitätsSpital Zürich, Klinik für Neurochirurgie, Zürich, Switzerland; UniversitätsSpital Zürich, Klinisches Neurozentrum, Zürich, Switzerland
  • Lennart H. Stieglitz - UniversitätsSpital Zürich, Klinik für Neurochirurgie, Zürich, Switzerland; UniversitätsSpital Zürich, Klinisches Neurozentrum, Zürich, Switzerland

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. DocV016

doi: 10.3205/19dgnc016, urn:nbn:de:0183-19dgnc0162

Veröffentlicht: 8. Mai 2019

© 2019 Krauss 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: Accuracy of lead placement is the key to success in deep brain stimulation (DBS). Precise anatomic stereotactic planning usually is based on high resolution tomography imaging and stable perioperative anatomy. Although pneumocephalus due to intraoperative CSF loss is a common procedure related phenomenon, it could lead to brain shift and consecutive targeting inaccuracy. Therefore, its avoidance is of utmost importance. The aim of this study was to evaluate potential risk factors of pneumocephalus in DBS surgery.

Methods: We performed a retrospective single centre analysis of patients undergoing bilateral STN DBS for Parkinson’s disease. We quantified the amount of pneumocephalus by intraoperative stereotactic CT scans and corrected the data for accompanying brain atrophy by an MRI based score. Therefore, automated computerized segmentation algorithms from a dedicated software were consistently used for each patient. As potential main risk factors, we evaluated the impact of trephination size (large 14 mm, small 8 mm, respectively), number of electrode tracks, surgery duration and brain atrophy.

Results: We included 100 consecutive patients that underwent awake DBS with microelectrode recording and intraoperative stimulation. The mean absolute amount of pneumocephalus was 1.3±2.8 cm3SD. Surgery duration was significantly correlated to pneumocephalus. No significant impact of trephination size or brain atrophy could be observed. Multiple trajectories led to longer surgery duration, whereas the bare number of electrode tracks did not correlate with a higher rate or amount of pneumocephalus. An equal volume of pneumocephalus was detected if 1 or ≥2 trajectories per hemisphere were used. Patients that required trajectory adjustments based on intraoperative neurophysiology did not show a higher rate or amount of pneumocephalus.

Conclusion: Our analysis identifies surgery duration as important risk factor for pneumocephalus in awake DBS with neurophysiological examination. Single or multiple electrode tracks, trephination size or brain atrophy increase not significantly the risk for pneumocephalus. Whether extensive neurophysiological examination might lead to prolonged surgery duration and therefore might cause more often pneumocephalus or if longer neurophysiological examination might be a consequence of pneumocephalus cannot finally be answered. However, our data suggests that the number of test stimulations does not generally increase the risk for pneumocephalus.