Deep brain stimulation of the VIM is an efficient and safe treatment for ET. Tremor and handwriting improvements in long-term follow-up are stable. The patients' perception of their outcome is quite good. However, tolerance may develop in some patients requiring changes in stimulation parameters.
Aims: Infection of hardware is a serious complication after deep brain stimulation (DBS), as this may result in additional surgery, cost and loss of treatment benefit for the patient. We report the incidence and management of infections after DBS in a single institution over the past 11 years. Methods: A database of 270 patients with 484 implants was used in the study. Incidence, clinical characteristics and management of infections were analyzed. Results: The overall infection rate was 9.3% (25/270) by patients and 6.8% (33/484) by episode/implants. The median time of infection after implantation was 64 days. Only 7/33 episodes (21.2%) occurred within 30 days after surgery, 22/33 episodes (66.7%) within 6 months and 28/33 episodes (84.8%) within 12 months. There was no age difference between infected and noninfected patients, while comorbidities were more frequent in the former. Infection rates before and after January 2003 were 14.3 and 4.9%, respectively. The rate of complete and partial hardware salvage was 30.3 and 21.2% while that of complete hardware removal was 48.5%. Patients with deep purulent infections and patients with Staphylococcus aureus as the causative organism were more likely to have their hardware removed. Conclusions: The incidence of hardware infections declined significantly over time. Improvements in hardware and implantation techniques may be responsible. Hardware can often be completely or partly saved in infected patients.
ObjectIn this paper, the authors' goal was to determine the utility of monitoring the abnormal muscle response (AMR) or “lateral spread” during microvascular decompression surgery for hemifacial spasm.MethodsThe authors' experience with AMR as well as the data available in the English-language literature regarding resolution or persistence of AMR and the resolution or persistence of hemifacial spasm at follow-up was pooled and subjected to a meta-analysis.ResultsThe pooled OR revealed by the meta-analysis was 4.2 (95% CI 2.7–6.7). The chance of a cure if the AMR was abolished during surgery was 4.2 times greater than if the lateral spread persisted.ConclusionsThe AMR should be monitored routinely in the operating room, and surgical decision-making in the operating room should be augmented by the AMR.
In the Intraoperative Hypothermia for Aneurysm Surgery Trial, neither systemic hypothermia nor supplemental protective drug affected short- or long-term neurologic outcomes of patients undergoing temporary clipping.
In patients undergoing either elective craniotomy or complex spine surgery, peripheral venous pressure (PVP) trends correlated with central venous pressure (CVP) trends with a mean offset of 3 mm Hg (PVP > CVP). PVP trends provided equivalent physiological information to CVP trends in this subset of patients, especially during periods of hemodynamic instability. In addition, measurements made during a planned circulatory arrest support the hypothesis that PVP approximates mean systemic pressure (systemic arrest pressure), which is a direct index of patient volume status independent of cardiac or respiratory activity.
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