Avoidance and Management of Surgical and Hardware-Related Complications of Deep Brain Stimulation

Abstract

Objective: Although deep brain stimulation (DBS) is nonablative, it may give rise to many complications. In order to identify and reduce factors contributing to the complications, we performed a retrospective analysis of patients who received DBS in our institution over a 9-year period from March 2000 to December 2008. Methods: Included in this study were 161 patients (85 male and 76 female). Data from these patients were collected and analyzed with respect to the complications and factors potentially related to these complications. Results: A total of 25 surgical and hardware-related complications occurred in 24 patients, including confusion in 11 cases (6.83%), asymptomatic intracranial hemorrhage in 1 case (0.62%), electrode misplacement in 2 cases (1.24%), infection of the subcutaneous pocket receiving the pulse generator in 1 case (0.62%), skin erosion in 2 cases (1.24%), pulse generator seroma formation in 6 cases (3.72%), and device malfunction in 1 case (0.62%). There was no permanent neurological deficit. Conclusion: Confusion is the most common complication in simultaneous bilateral DBS targeting the subthalamic nucleus, especially in patients with severe Parkinson’s disease. With increasing experience of surgeons, complete obedience to intraoperative surgical routines and reasonable application of the microelectrode recording technique, other complications could also be reduced.

Deep Brain Stimulation Hardware Complications in Patients with Movement Disorders: Risk Factors and Clinical Correlations

“…Infection is one of the most feared complications of DBS as it usually requires complete hardware removal and a potential risk of intracranial infection [10,29,30,31,32]. The time from the implantation to infection varies in different reports, but according to our study most cases occur within the first 2 years, and some of them within days after the implantation, presumably due to contamination during the surgery [29].…”

Complications of Subthalamic Nucleus Stimulation in Parkinson's Disease

“…4,7,10,14,17,18,[20][21][22][23][24]27,28) Most are mild and transient, but some serious morbidity also occurs. The mortality rate during the first 30 postoperative days after stereotactic surgery was 0.4%, and the permanent surgical morbidity rate was 1%, mainly caused by ICH (2.2%) in a large series (1183 patients).…”

“…25) Device infection is one of the most probable device-related complications in DBS. 2,4,10,14,17,22,24) Since the DBS procedure involves the implantation of a foreign body, the risk of infection is high. Recent reported incidence of device infection varies from 0.4% to 10%.…”

“…8) DBS is considered to cause less morbidity than ablative procedures, but is associated with a significant incidence of adverse effects. 4,7,10,14,17,18,[20][21][22][23][24]27,28) In this study, we retrospectively analyzed DBSrelated complications in a consecutive series of 180 patients who underwent bilateral STN-DBS to consider preventive methods.…”

Long-Term Surgical and Hardware-Related Complications of Deep Brain Stimulation

“…Some of the complications are related to surgical procedures, particulary to neurosurgery [1,2] , while others are specific to DBS such as hardware complications [3][4][5] and stimulation-induced side effects that are unique to DBS. Most of the literature on surgical and hardware complications was published before 2007, except for two studies from Asia [6,7] . …”