Experience Reduces Surgical and Hardware-Related Complications of Deep Brain Stimulation Surgery: A Single-Center Study of 181 Patients Operated in Six Years

Abstract

Objective Deep brain stimulation (DBS) surgery has increasingly been performed for the treatment of movement disorders and is associated with a wide array of complications. We aimed to present our experience and discuss strategies to minimize adverse events in light of this contemporary series and others in the literature. Methods A retrospective chart review was conducted to collect data on age, sex, indication, operation date, surgical technique, and perioperative and late complications. Results A total of 181 patients (113 males, 68 females) underwent DBS implantation surgery (359 leads) in the past six years. Indications and targets were as follows: Parkinson's disease (STN) (n=159), dystonia (GPi) (n=13), and essential tremor (Vim) (n=9). Mean age was 55.2 ± 11.7 (range 9–74) years. Mean follow-up duration was 3.4 ± 1.6 years. No mortality or permanent morbidity was observed. Major perioperative complications were confusion (6.6%), intracerebral hemorrhage (2.2%), stroke (1.1%), and seizures (1.1%). Long-term adverse events included wound (7.2%), mostly infection, and hardware-related (5.5%) complications. Among several factors, only surgical experience was found to be related with overall complication rates (early period: 31% versus late period: 10%; p=0.001). Conclusion The rates of both early and late complications of DBS surgery are acceptably low and decrease significantly with cumulative experience.

Five-Year Clinical Outcomes of Local versus General Anesthesia Deep Brain Stimulation for Parkinson’s Disease

“…One patient in the GA group developed intracranial hematoma and hemiparesis after STN-DBS and another patient had asymptomatic intracranial hematoma in the same group. Although there was no hemorrhage in the LA group, the incidence of intracranial hematoma in the GA group was similar to the previously reported complications from either awake or asleep DBS procedures [7, 24]. There were no significant differences with regard to other stimulation adverse effects between the GA and LA groups in our report, a result that could be anticipated because of both groups having equivalent coordinates of active contacts [25–27].…”

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

“…The main descriptive characteristics of the eligible studies are summarized in Table 1. All studies were of cohort design yielding a total sample size of 12,258 participants (10,42–106). The follow‐up period ranged from 0.5 to 22 years (median: 3.35 years).…”

Postoperative Externalization of Deep Brain Stimulation Leads Does Not Increase Infection Risk

“…A further, more recent meta‐analysis examining the rate of wound complications necessitating hardware removal determined a rate of 3.8% per patient (18), though this may underestimate the true infection rate given that a significant proportion of infections may be managed without explantation (e.g., see case 3) (19). Examination of even more recent case series published within the last three years yields similar figures of between 0% and 10.9% with the proviso of significant heterogeneity in the way infection was defined (e.g., the inclusion of skin erosion without signs of infection), denominators used (e.g., patients, procedures, or implants), duration of follow‐up, inclusion of revision surgery in addition to primary implants, surgical technique, anti‐infection measures trialed during the studies, and patient factors (14,18,20–42).…”