Deep Brain Stimulation-Related Surgical Site Infections: A Systematic Review and Meta-Analysis

Καντζάνου, Μαρία; Korfias, Stefanos; Panourias, I. G.; Sakas, Damianos E.; Karalexi, Maria A.

doi:10.1111/ner.13354

Cited by 37 publications

(39 citation statements)

References 124 publications

(164 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Wound complications, especially infection, are among the most frequent and concerning hardware-related complications. While the incidence of infection ranged from 0 to 15.2% (Sixel-Doring et al, 2010;Bjerknes et al, 2014;Kim et al, 2017;Hardaway et al, 2018;Kantzanou et al, 2021), merely two patients (0.89%) experienced subcutaneous exudate in this cohort and were soon cured after local compression dressing and antibiotic administration. Regrading wound complications, our rationale is that the probability of such events can be minimized by the long-term efforts of a specialized operation team with strict enforcement of sterility, and reductant surgical modifications.…”

Section: Discussionmentioning

confidence: 72%

See 1 more Smart Citation

Deep Brain Stimulation Complications in Patients With Parkinson’s Disease and Surgical Modifications: A Single-Center Retrospective Analysis

Wang

Chen

et al. 2021

Front. Hum. Neurosci.

View full text Add to dashboard Cite

BackgroundAs a complication-prone operation, deep brain stimulation (DBS) has become the first-line surgical approach for patients with advanced Parkinson’s disease (PD). This study aimed to evaluate the incidence and risk factors of DBS-associated complications.MethodsWe have reviewed a consecutive series of patients with PD undergoing DBS procedures to describe the type, severity, management, and outcome of postoperative complications from January 2011 to December 2018. Both univariate and multivariate analyses were performed to identify statistically significant risk factors. We also described our surgical strategies to minimize the adverse events.ResultsA total of 225 patients underwent 229 DBS implantation procedures (440 electrodes), of whom 20 patients experienced 23 DBS-associated complications, including ten operation-related complications and 13 hardware-related ones. Univariate analysis elucidated that comorbid medical conditions (P = 0.024), hypertension (P = 0.003), early-stage operation (P < 0.001), and unilateral electrode implantation (P = 0.029) as risk factors for overall complications, or more specifically, operation-related complications demonstrated in the stratified analysis. In contrast, no risk factor for hardware-related complications was identified. Statistical significances of hypertension (OR = 3.33, 95% CI: 1.14–9.71, P = 0.027) and early-stage (OR = 11.04, 95% CI: 2.42–50.45, P = 0.002) were further validated via multivariate analysis. As the annual number of DBS procedures increased, the incidence of complications gradually decreased (R = −0.699, P < 0.01). Additionally, there was a strong correlation between surgical complications and unplanned readmission (R = 0.730, P < 0.01).ConclusionThe importance of cumulative experience and relevant technique modifications should be addressed to prevent DBS-associated complications and unplanned readmission.

show abstract

Section: Discussionmentioning

confidence: 72%

“…In most cases, the overall benefits of DBS surgery greatly outweigh its risks. Despite the good tolerability and safety of this therapeutic approach, a broad range of DBS-related complications have arisen, which marks it a complication-prone operation (Boviatsis et al, 2010;Rughani et al, 2013;Kantzanou et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Deep Brain Stimulation Complications in Patients With Parkinson’s Disease and Surgical Modifications: A Single-Center Retrospective Analysis

Wang

Chen

et al. 2021

Front. Hum. Neurosci.

View full text Add to dashboard Cite

show abstract

“…The most common issues for DBS are surgical site infection and hardware problems, which account for 1.4-5.4% of cases. 5,51) Simply looking at the number, the occurrence of such infection or hardware problems is not high, but in cases where it occurs, the entire system of implanted DBS, which places a heavy burden on the patient, should be removed. Considering these comparisons, DBS may be the most recommended treatment at present, especially for severe ET.…”

Section: Outcomes and Safety Of Mrgfus: Can Mrgfus Surpass Dbs?mentioning

confidence: 99%

“…Noninvasiveness and good outcomes in this novel modality are driving this trend; however, DBS has recently been criticized for undesirable complications such as hardware-related infection. 5) Is MRgFUS a treatment that surpasses DBS? What is the difference between MRgFUS and conventional RF ablation?…”

Section: Introductionmentioning

confidence: 99%

Techniques, Indications, and Outcomes in Magnetic Resonance-guided Focused Ultrasound Thalamotomy for Tremor

Maesawa

Nakatsubo

Tsugawa

et al. 2021

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

Magnetic resonance (MR)-guided focused ultrasound surgery (MRgFUS) is the latest minimally invasive stereotactic procedure, and thalamotomy using this novel modality has demonstrated its effectiveness and safety, especially for patients with essential tremor (ET) and Parkinson's disease (PD). In Japan, the application of MRgFUS to treat ET and PD has recently been covered by health insurance. Technically, the transducer with 1024 elements emits ultrasound beams, which are then focused on the target with a phase control, resulting in optimal ablation by thermal coagulation. The technical advantages of MRgFUS are continuous intraoperative monitoring of clinical symptoms and MR images and fine adjustment of the target by the steering function. Postoperative tremor control is compatible with other modalities, although long-term follow-up is necessary. The adverse effects are usually transient and acceptable. Prognostic factors for good tremor control include high temperature and large lesion size. A high skull density ratio is a factor to achieve high temperature and large lesioning, but it may not be necessary and sufficient for clinical outcomes. For patients with advanced symptoms such as bilateral tremor or head/neck tremor, deep brain stimulation may be recommended because of the adjustability of stimulation and the possibility of bilateral treatment. Patients have high expectations of MRgFUS because of its non-invasiveness. To perform this treatment safely and effectively, physicians need to understand the technological aspects, the physiological principles. To choose the appropriate modality, physicians also should recognize the clinical advantages and disadvantages of MRgFUS compared to other modalities.

show abstract

“…Deep brain stimulation (DBS) of the subthalamic nucleus or the internal globus pallidus is an effective treatment option for advanced PD refractory to oral pharmacotherapy, with good response to motor and nonmotor symptoms, including pain syndrome [ 27 ]. However, the surgical procedure is complex, expensive, and offers risks to patients, such as perioperative, hardware-related complications and side effects [ 28 , 29 , 30 ]. There are also some contraindications for DBS, including levodopa-resistant motor symptoms, chronic immunosuppression, dementia, psychiatric disorders, and structural brain abnormalities [ 31 , 32 ].…”

Section: Introductionmentioning

confidence: 99%

Motor Cortex Stimulation Reversed Hypernociception, Increased Serotonin in Raphe Neurons, and Caused Inhibition of Spinal Astrocytes in a Parkinson’s Disease Rat Model

Campos

Berzuino

Barbosa

et al. 2021

Cells

View full text Add to dashboard Cite

Persistent pain is a prevalent symptom of Parkinson’s disease (PD), which is related to the loss of monoamines and neuroinflammation. Motor cortex stimulation (MCS) inhibits persistent pain by activating the descending analgesic pathways; however, its effectiveness in the control of PD-induced pain remains unclear. Here, we evaluated the analgesic efficacy of MCS together with serotonergic and spinal glial modulation in an experimental PD (ePD) rat model. Wistar rats with unilateral striatal 6-OHDA and MCS were assessed for behavioral immobility and nociceptive responses. The immunoreactivity of dopamine in the substantia nigra and serotonin in the nucleus raphe magnus (NRM) and the neuronal, astrocytic, and microglial activation in the dorsal horn of the spinal cord were evaluated. MCS, without interfering with dopamine loss, reversed ePD-induced immobility and hypernociception. This response was accompanied by an exacerbated increase in serotonin in the NRM and a decrease in neuronal and astrocytic hyperactivation in the spinal cord, without inhibiting ePD-induced microglial hypertrophy and hyperplasia. Taken together, MCS induces analgesia in the ePD model, while restores the descending serotonergic pathway with consequent inhibition of spinal neurons and astrocytes, showing the role of MCS in PD-induced pain control.

show abstract

Deep Brain Stimulation-Related Surgical Site Infections: A Systematic Review and Meta-Analysis

Cited by 37 publications

References 124 publications

Deep Brain Stimulation Complications in Patients With Parkinson’s Disease and Surgical Modifications: A Single-Center Retrospective Analysis

Deep Brain Stimulation Complications in Patients With Parkinson’s Disease and Surgical Modifications: A Single-Center Retrospective Analysis

Techniques, Indications, and Outcomes in Magnetic Resonance-guided Focused Ultrasound Thalamotomy for Tremor

Motor Cortex Stimulation Reversed Hypernociception, Increased Serotonin in Raphe Neurons, and Caused Inhibition of Spinal Astrocytes in a Parkinson’s Disease Rat Model

Contact Info

Product

Resources

About