Article
Prevention of surgical morbidity in deep brain stimulation surgery
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Published: | May 21, 2013 |
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Outline
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Objective: Deep brain stimulation (DBS) surgery is a well accepted treatment option in movement disorders, especially in medication refractory tremor or dystonia. Because of the complexity of their disease patients with Parkinson’s disease (PD) might be more vulnerable to surgical complications such as cardiovascular or vegetative disturbances and hemorrhages. The focus of the present study was an analysis of early and long-term surgical sequels in these subgroups.
Method: In a consecutive series of 42 patients stereotactic DBS surgery was carried out by stereotactic means including detailed MRI-planning, microrecording, semimacro-test-stimulation, macro-test-stimulation and a special mode of electrode fixation with titan mini plates. The incidence of intracerebral hemorrhage, wound infection, healing disturbances, epilepsy, confusion syndrome, psychosis, depression and long-term findings such as scar pain, cosmetic side effects and traction.
Results: DBS operations were carried out for tremor in 11, for dystonia in 14 and for PD in 16 cases. One dystonia patient experienced a seizure due to a small subdural hemorrhage; otherwise there was no intracerebral hemorrhage and no infection. One patient with PD showed an allergy to the implant material with repeated effusions along the connection cables and around the stimulator necessitating explantation of the material. Local traction effects of the connection cables are prominent in 2 patients leading to subjective disturbance in one. 3 PD patients suffered from transitory confusion syndrome with complete resolution within 2 weeks. There were no complains regarding scars or cosmetic side effects.
Conclusions: Major complications such as intracerebral bleeding or severe infection could be avoided in either treatment indication. Precise patient selection and pre-planning of surgery by the interdisciplinary team are essential elements regarding safety in this treatment modality. The only disadvantageous aspect specific in DBS for PD is the risk of temporary confusion syndrome.