gms | German Medical Science

72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Postoperative confusion state in combined STN and NBM DBS in mild to moderate Parkinson’s dementia

Postoperatives Delir nach kombinierter tiefer Hirnstimulation im STN und NBM bei leichter bis moderater Parkinson-Demenz

Meeting Abstract

  • presenting/speaker Robert Nickl - Universitätsklinikum Julius Maximilians Universität Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Patrick Fricke - Universitätsklinikum Julius Maximilians Universität Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Ibrahem Hanafi - Universitätsklinikum Julius Maximilians Universität Würzburg, Neurologische Klinik und Poliklinik, Würzburg, Deutschland
  • Hazem ElDeBakey - Universitätsklinikum Julius Maximilians Universität Würzburg, Neurologische Klinik und Poliklinik, Würzburg, Deutschland
  • Christine Daniels - Universitätsklinikum Julius Maximilians Universität Würzburg, Neurologische Klinik und Poliklinik, Würzburg, Deutschland
  • Ralf-Ingo Ernestus - Universitätsklinikum Julius Maximilians Universität Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Jens Volkmann - Universitätsklinikum Julius Maximilians Universität Würzburg, Neurologische Klinik und Poliklinik, Würzburg, Deutschland
  • Martin Reich - Universitätsklinikum Julius Maximilians Universität Würzburg, Neurologische Klinik und Poliklinik, Würzburg, Deutschland
  • Cordula Matthies - Universitätsklinikum Julius Maximilians Universität Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocP218

doi: 10.3205/21dgnc500, urn:nbn:de:0183-21dgnc5003

Published: June 4, 2021

© 2021 Nickl et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: PD dementia (PDD) patients are excluded from the highly effective treatment of STN-DBS since dementia is an accepted contraindication. The DEMPARK study is an ongoing phase-1b trial at our institution with an exploratory endpoint on cognition by combined STN and Nucleus basalis of Meynert (NBM) DBS. Postoperative confusion state was frequently observed after implantation. Here we focus on lead location and its correlation with induction of postoperative delirium.

Methods: Patients received asleep STN and NBM DBS. Indirect targeting of the NBM considered landmarks such as convergence of the optic tract and the temporal crus of the anterior commissure and the level inferior to the external pallidum. Fusion of post-op CT to pre-op MRI and clinical protocols served for analysis of adverse events and sequels, of lead sites in relation to postoperative confusion.

Results: Combined STN & NBM implantation was carried out in 10 patients (all male, Ø65.4 years, pre-op: MMST 22.6, UPDRS On/ Off 48.6 / 19.6, UPDRS Stim-On/ Med off 32.2). Any penetration of the ventricles or the caudate nucleus as well as crossing or disturbance of trajectories could always be avoided. Definite lead sites for the designated active contact were identified at 24.9 mm lateral, 7.6 mm anterior and 5.0 mm inferior to the midpoint. Transient delirium occurred in 7 patients (4 hypoactive, 3 hyperactive). Lead location of patients with hypoactive delirium was clustered with more medial lead placement.

Conclusion: Combined STN/ NBM implantation was conducted while critical surgical sequels such as hemorrhage or infection could be avoided. Of notice, more than half of the patients developed a postoperative confusion state. Currently it remains uncertain whether this is to be attributed to rather long anesthesia in pre-demented patients or related to a stun effect due to inhibition of cholinergic transmission which could be linked especially to hypoactive delirium.

Figure 1 [Fig. 1]