An Evaluation of Hardware and Surgical Complications with Deep Brain Stimulation Based on Diagnosis and Lead Location

Abstract

Introduction: Deep brain stimulation is the most frequently performed neurosurgical procedure for movement disorders. This procedure is well tolerated, but not free of complications. Analysis of hardware complications based on patient diagnosis and lead location could prove valuable in recognizing potential pitfalls and patients at higher risk. Methods: This review analyzes the most common surgery-related complications that may occur based on diagnosis and lead location. Patients were categorized based on diagnosis – Parkinson’s disease (PD), dystonia, and essential tremor (ET) – as well as by lead location – subthalamic nucleus (STN), globus pallidus interna (GPi), and ventral intermediate nucleus of the thalamus (Vim). It is a retrospective review of 326 patients undergoing 949 procedures over a 10-year period by one surgeon. Fisher’s exact test and χ² test were employed and multivariate logistic regression analysis was performed to identify the significant variables of correlation. Results: Overall lead revision was observed at 5.7%, but was observed at 11.9% of GPi lead placements, and 10.7% of dystonia patients with only 4.6% of STN lead placements. Total extension revision was at 2.5%, but observed at 5.3% for dystonia patients and at only 1.4% for ET patients. Overall infection rate was at 1.9% with the highest rate observed in dystonia and ET patients. Postoperative complications with hardware, erosion, infection, and delayed stimulation failure were observed more often with ET and dystonia than with PD. This difference was statistically significant between dystonia and PD (p < 0.03) but not between the other disease entities (p > 0.05). On multivariate analysis, age and gender had no correlation with these complications. PD had significantly fewer complications on forward selection regression analysis (p = 0.004). Asymptomatic intracerebral hemorrhage was at 2.5% with the majority in Vim and none observed in GPi placements. There was only one symptomatic hemorrhage with a permanent deficit. Infarcts were observed at 0.8%. There were no mortalities. Conclusion: This large series of patients and long-term follow-up demonstrate that risks of complications are not universal among movement disorder patients. Diagnosis and lead location are important risk stratification factors in determining complications.

The Factors Involved in Deep Brain Stimulation Infection: A Large Case Series

“…Sixel-Doring et al [26] in turn found that age, gender, disease duration, disease severity, hypertension and diabetes were not statistically more likely to cause infection in their PD population. Finally, Falowski et al [27] felt that surgical indications for ET and dystonia raised the risk of infection, whereas Piacentino et al [12] felt that the risk was higher with PD patients.…”

Bilateral thermal capsulotomy with MR-guided focused ultrasound for patients with treatment-refractory obsessive-compulsive disorder: a proof-of-concept study

“…DBS also requires specific programming and additional operations for battery changes, in addition to being a costly device. 10,11,22 Typically, both destructive and nondestructive procedures have been beneficial in~40-60% of medically refractory OCD patients. 6,7,9,17,[23][24][25][26][27] Compared with conventional radiofrequency thermal capsulotomy or gamma capsulotomy, MRgFUS enabled us to create an exact and accurate lesion in the pre-planned target because of the real-time, closed-loop monitoring of the MR thermometry and sequential MR images.…”

Deep-Brain Stimulation for Parkinson's Disease

“…48 Lead fractures and other hardware-related issues are not uncommon. 49 A wide range of neurologic and neuropsychological adverse effects has been reported with deep-brain stimulation. Some of these effects are related to device implantation and may require electrode relocation or, in some cases, may be permanent.…”