Article
Risk of deep-brain stimulation: Impact of surgery and hardware components
Risiko der Tiefenhirn-Stimulation: Einfluss von chirurgischem Eingriff und implantierten Systemkomponenten
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Published: | April 23, 2004 |
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Outline
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Objective
To determine complications caused by surgery and/or implanted hardware components.
Methods
From 02/1996 through 03/2003, 262 patients were treated with Deep-Brain Stimulation for movement disorders (n=245), ,pain (n=10) , or OCD (n=7) in our institution. Ventriculography (optional), CT/MRI image fusion and computerized 3D-multiplanar treatment planning were used for stereotactic implantation of quadrupolar stimulation electrodes. Additional routine measures were intraoperative macrostimulation and teleradiography. Microrecording, measurement of local field potentials and fMRI were applied in selected cases.
Results
In 262 pts. (= 437 leads) - 50% of them being older than 60 years (mean age: 56.5±13.1 years) - intra- and perioperative complications were documented. Termination of the procedure (3.2%) was the only intraoperative complication. Postoperatively (up to 10 days after surgery), subarachnoidal hemorrhage was incidentally documented in one case (0.4%). Other adverse events were subcutaneous bleeding (lead extension/generator pouch: 1.6%), and transient (0.6%) or permanent (1.1%) neurological deficits. 180/262 pts (= 325 leads) were available for retrospective analysis of long-term side effects (mean actuarized follow-up: 35.3±21.0 months). The main surgery related complications were superficial wound infections (6.7%), and dislocation of brain electrodes (2.3%). Hardware related problems (e. g. fracture of electrodes) were registered in 5/180 cases (2.8%).
Conclusions
Stereotactic implantation of electrodes for DBS if performed with sophisticated treatment planning programs is a safe procedure which can also be performed in elderly patients with no mortality and extreme low morbidity (1.8%). Hardware related complications are rare. Local infection seems to be the most frequent adverse event.