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

Abstract

Objective: To evaluate the incidence of surgical and hardware-associated complications of deep brain stimulation (DBS) for a range of movement disorders. Methods: The study design is a retrospective analysis and review of surgical and hardware complications of DBS performed by a single surgeon from 1999 to 2009. A total of 153 cases of DBS (298 electrodes) for various movement disorders and a minimum follow-up of 1 year have been included. Two patients could not be implanted. A further 54 patients who underwent change of the implantable pulse generator (IPG) have been included for analysis of hardware-related complications. Results: The mean follow-up was 64 ± 36.15 (range = 12–129) months for the DBS group. Twenty-four (15.6%) patients developed complications. Confusion occurred in 3.9%, vasovagal attack in 1.9%, lead migration/misplaced lead in 2.5%, erosion and infection in 4.5% and IPG malfunction occurred in 1.4% of the patients. When calculated with respect to the number of electrodes and IPG replacements, the complication rate was lower (11.9%). Three patients had their system explanted, two of them being patients with dystonia who had inadvertently damaged their operative site. Conclusion: DBS surgery is a relatively safe surgery, with most of the complications being minor, without long-term morbidity. The complication rate in elderly (age ≧65 years) is comparable to that in younger patients. However, confusion is more frequent in this age group, and patients and relatives can be prepared to accept this as a transient morbidity.

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

“…The rate of infection remained consistently very low the last 5-6 years during the study period. Age at the time of surgery was not found to be statistically significant (p = 0.13) when comparing infected and noninfected groups, confirming the more predominant finding in the literature [9,10,12,13,26]. There was a higher number of PD patients with infection, but this was, by far, the largest group which underwent DBS.…”

“…The rate of infection, especially the 2.01%, compares favorably across published studies. Still, it is difficult to compare percentages directly because different authors use a variety of criteria to define postsurgical DBS infection [7,8,9,10,11,12,13,14,15,16,17,18]. …”

“…Age at surgery is one factor of concern but its effects are unclear. Various authors have stated that older age [25] and younger age [17] can increase the risk as well as that it is not a factor at all [9,10,12,13,26]. Bhatia et al [10] identified several other factors, asserting that skin erosion, medical comorbidities, scalp thickness and burr hole cap thickness were all either risks for infection or higher in the infected patients in their retrospective review.…”

“…Reported infection rates have varied considerably through the literature from 0.4 to 23%, likely secondary to differing surgical techniques, infection-preventative techniques, definitions of infection, infection computation (e.g. per surgery or per patient) and patient population [7,8,9,10,11,12,13,14,15,16,17,18]. The physical, economic and emotional repercussions of treating an infection and potential subsequent removal of the DBS hardware can be considerable [17].…”

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

“…Although systemic diseases such as diabetes mellitus, smoking, and relative scalp thinness may theoretically lead to an increased risk of infection, no study has identified any of these factors as definitive risk for infections [17,29,33,34,35,36,37,38,39]. In our study, only 1 patient with hardware-related infection had diabetes mellitus, and none had a known immunodeficiency, precluding a statistical analysis for risk factors.…”