Surgical adverse events of deep brain stimulation in the subthalamic nucleus of patients with Parkinson’s disease. The learning curve and the pitfalls

Seijo, F.; Beramendi, Sayoa Alvarez de Eulate; Liébana, Elena Santamarta; Aragoneses, Beatriz Lozano; Ayala, Antonio Saiz; León, Ramón Fernández de; Álvarez-Vega, Marco

doi:10.1007/s00701-014-2082-0

Cited by 31 publications

(34 citation statements)

References 37 publications

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“…This is lower than the reported infection rate in many DBS series 12,35,41 (Table 3) and lower than our own hardware infection rate for DBS in cases where ECoG was not used. 38 Nevertheless, adding ECoG to DBS surgery extends the operative time slightly, which is a risk factor for infection in many surgical procedures.…”

Section: Discussioncontrasting

confidence: 70%

Intraoperative electrocorticography for physiological research in movement disorders: principles and experience in 200 cases

Panov

Levin

Hemptinne³

et al. 2017

JNS

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OBJECTIVE Contemporary theories of the pathophysiology of movement disorders emphasize abnormal oscillatory activity in basal ganglia-thalamocortical loops, but these have been studied in humans mainly using depth recordings. Recording from the surface of the cortex using electrocorticography (ECoG) provides a much higher amplitude signal than depth recordings, is less susceptible to deep brain stimulation (DBS) artifacts, and yields a surrogate measure of population spiking via “broadband gamma” (50–200 Hz) activity. Therefore, a technical approach to movement disorders surgery was developed that employs intraoperative ECoG as a research tool. METHODS One hundred eighty-eight patients undergoing DBS for the treatment of movement disorders were studied under an institutional review board–approved protocol. Through the standard bur hole exposure that is clinically indicated for DBS lead insertion, a strip electrode (6 or 28 contacts) was inserted to cover the primary motor or prefrontal cortical areas. Localization was confirmed by the reversal of the somatosensory evoked potential and intraoperative CT or 2D fluoroscopy. The ECoG potentials were recorded at rest and during a variety of tasks and analyzed offline in the frequency domain, focusing on activity between 3 and 200 Hz. Strips were removed prior to closure. Postoperative MRI was inspected for edema, signal change, or hematoma that could be related to the placement of the ECoG strip. RESULTS One hundred ninety-eight (99%) strips were successfully placed. Two ECoG placements were aborted due to resistance during the attempted passage of the electrode. Perioperative surgical complications occurred in 8 patients, including 5 hardware infections, 1 delayed chronic subdural hematoma requiring evacuation, 1 intraparenchymal hematoma, and 1 venous infarction distant from the site of the recording. None of these appeared to be directly related to the use of ECoG. CONCLUSIONS Intraoperative ECoG has long been used in neurosurgery for functional mapping and localization of seizure foci. As applied during DBS surgery, it has become an important research tool for understanding the brain networks in movement disorders and the mechanisms of therapeutic stimulation. In experienced hands, the technique appears to add minimal risk to surgery.

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Section: Discussioncontrasting

confidence: 70%

Intraoperative electrocorticography for physiological research in movement disorders: principles and experience in 200 cases

Panov

Levin

Hemptinne³

et al. 2017

JNS

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“…However, other possible mechanisms could be responsible, since we observed a worsening of symptoms when DBS was suddenly stopped due to electrode breakage or battery depletion, as occurred in cases 1, 2, 3, 4, 5, 8, 9, and 11, with the patients returned to the prior improvement once the problem was solved. The surgical and mechanical adverse effects in our series are similar to those in other published series [7,21,22] and to those of DBS for Parkinson's disease [37,38]. Based to the information described above, we hypothesize that the action of DBS on CCH is due to orthodromic and antidromic neuromodulation over both the MTF and the DLF.…”

Section: Discussionsupporting

confidence: 71%

Long-Term Results of Deep Brain Stimulation of the Mamillotegmental Fasciculus in Chronic Cluster Headache

Seijo-Fernández¹,

Sáiz

Santamarta

et al. 2018

Stereotact Funct Neurosurg

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Background: Deep brain stimulation (DBS) and the proper target for chronic cluster headache (CCH) are still subjects of controversy. Objectives: We present our long-term results of analysis of the target and its structural connectivity. Methods: Fifteen patients with drug-resistant CCH underwent DBS in coordinates 4 mm lateral to the III ventricular wall and 2 mm behind and 5 mm below the intercommissural point. The clinical parameters recorded were the number of weekly attacks, pain intensity, and duration of the headache. Structural connectivity was studied using 3-T MR diffusion tensor imaging (DTI). Results: All of our patients improved from a mean of 39 attacks/week to 2; pain intensity decreased from 9 to 3 out of 10, and the mean cephalalgia duration decreased from 53 to 8 min. The mean stereotactic coordinates of the effective contact location were 6.1 mm lateral to the midcommissural point and 1.2 mm behind and 4.0 mm below the intercommissural point. DTI analysis showed that this target was connected to tracts and nuclei of the posterior mesencephalic tegmentum, specifically the dorsal longitudinal and mamillotegmental fasciculi. Conclusions: Our data showed DBS to be a safe and useful procedure for the treatment of drug-resistant CCH; the rate of improvement was higher than those found in other series. Although these are promising results, larger series targeting those fasciculi with a longer follow-up are needed.

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“…However, anesthetics, analgesics, and sedatives can interfere with ventilation and hemodynamic stability [36,41]. Cases of myocardial infarction [42] or panic attacks with abortion of the procedure [43] have been reported. In addition, these drugs can compromise the patient's alertness and cooperativeness, the quality of microelectrode recordings, and the recognition of undesired stimulation effects [17,36].…”

Section: Introductionmentioning

confidence: 98%

Anesthesiologic regimen and intraoperative delirium in deep brain stimulation surgery for Parkinson's disease

Lange

Zech

Seemann

et al. 2015

Journal of the Neurological Sciences

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Surgical adverse events of deep brain stimulation in the subthalamic nucleus of patients with Parkinson’s disease. The learning curve and the pitfalls

Abstract: STN DBS in PD patients is a safe surgical procedure, with good risk/benefit ratios: procedure reliability/correct lead implantation in 95.59 %, 0 mortality/implanted lead, 0.12 morbidity/implanted lead, and 0.0043 neurological sequelae/implanted lead.

Cited by 31 publications

References 37 publications

Intraoperative electrocorticography for physiological research in movement disorders: principles and experience in 200 cases

Intraoperative electrocorticography for physiological research in movement disorders: principles and experience in 200 cases

Long-Term Results of Deep Brain Stimulation of the Mamillotegmental Fasciculus in Chronic Cluster Headache

Anesthesiologic regimen and intraoperative delirium in deep brain stimulation surgery for Parkinson's disease

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