Surgical and hardware complications in subthalamic nucleus deep brain stimulation

Chou, Yu-Cheng; Lin, Shinn Zong; Hsieh, Wanhua Annie; Lin, Sheng Huang; Lee, Chao Chin; Hsin, Yue Long; Yen, Pao-Sheng; Lee, Chi Wei; Chiu, Wen Ta; Chen, Shin-Yuan

doi:10.1016/j.jocn.2006.02.016

Cited by 34 publications

(23 citation statements)

References 30 publications

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“…The incidence in DBS procedures is low, ranging from 0.7 to 3.3% per lead with a permanent morbidity of 0.6–0.8% [23,24,25,26]. In a study by Binder et al [27], there were a total of 5 symptomatic hematomas and 6 asymptomatic hematomas in 357 lead implants.…”

Section: Discussionmentioning

confidence: 99%

An Evaluation of Hardware and Surgical Complications with Deep Brain Stimulation Based on Diagnosis and Lead Location

Falowski¹,

Ooi

Smith³

et al. 2012

Stereotact Funct Neurosurg

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Introduction: Deep brain stimulation is the most frequently performed neurosurgical procedure for movement disorders. This procedure is well tolerated, but not free of complications. Analysis of hardware complications based on patient diagnosis and lead location could prove valuable in recognizing potential pitfalls and patients at higher risk. Methods: This review analyzes the most common surgery-related complications that may occur based on diagnosis and lead location. Patients were categorized based on diagnosis – Parkinson’s disease (PD), dystonia, and essential tremor (ET) – as well as by lead location – subthalamic nucleus (STN), globus pallidus interna (GPi), and ventral intermediate nucleus of the thalamus (Vim). It is a retrospective review of 326 patients undergoing 949 procedures over a 10-year period by one surgeon. Fisher’s exact test and χ² test were employed and multivariate logistic regression analysis was performed to identify the significant variables of correlation. Results: Overall lead revision was observed at 5.7%, but was observed at 11.9% of GPi lead placements, and 10.7% of dystonia patients with only 4.6% of STN lead placements. Total extension revision was at 2.5%, but observed at 5.3% for dystonia patients and at only 1.4% for ET patients. Overall infection rate was at 1.9% with the highest rate observed in dystonia and ET patients. Postoperative complications with hardware, erosion, infection, and delayed stimulation failure were observed more often with ET and dystonia than with PD. This difference was statistically significant between dystonia and PD (p < 0.03) but not between the other disease entities (p > 0.05). On multivariate analysis, age and gender had no correlation with these complications. PD had significantly fewer complications on forward selection regression analysis (p = 0.004). Asymptomatic intracerebral hemorrhage was at 2.5% with the majority in Vim and none observed in GPi placements. There was only one symptomatic hemorrhage with a permanent deficit. Infarcts were observed at 0.8%. There were no mortalities. Conclusion: This large series of patients and long-term follow-up demonstrate that risks of complications are not universal among movement disorder patients. Diagnosis and lead location are important risk stratification factors in determining complications.

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Section: Discussionmentioning

confidence: 99%

An Evaluation of Hardware and Surgical Complications with Deep Brain Stimulation Based on Diagnosis and Lead Location

Falowski¹,

Ooi

Smith³

et al. 2012

Stereotact Funct Neurosurg

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“…Downward migrations seem to be more common in patients with the Kinetra model rather than Soletra, possibly because of a difference in the IPG weights: 83 versus 42 g, respectively. Firm fixation to the muscle fascia, periosteum, and even the clavicle has been recommended to avoid this complication, particularly in slim patients 37…”

Section: Ipg Migrationsmentioning

confidence: 99%

Diagnosis and treatment of complications related to deep brain stimulation hardware

2011

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Deep brain stimulation is a therapeutic technique increasingly used in the treatment of a variety of neurological, psychiatric, and pain disorders. Although beneficial, it carries the immediate and long-term risks associated with implanted hardware in the brain parenchyma and subcutaneous tissue. The most common hardware complications include electrode migrations or misplacements, wire fractures, skin erosion, infections, and device malfunction. We systematically reviewed the literature on deep brain stimulation-related complications and propose a diagnostic and therapeutic algorithm. Our aim is to provide a guide for clinicians and medical staff involved in the treatment of patients with deep brain stimulation for rapid recognition and efficient management of these complications.

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“…The incidence of reported DBS-related infections varies from 0 to 22% [3,4]. However, published data often neglects to mention the type of surgery related to the infection.…”

Section: Introductionmentioning

confidence: 99%

The Risk of Hardware Infection in Deep Brain Stimulation Surgery Is Greater at Impulse Generator Replacement than at the Primary Procedure

Pepper¹,

Zrinzo²,

Mirza³

et al. 2012

Stereotact Funct Neurosurg

136

112

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Background/Aims: Infection of implanted hardware after deep brain stimulation (DBS) has a significant impact on patient morbidity. We examined all patients who underwent DBS procedures over the last 9 years in our centre to assess the infection rate and possible factors related to surgery that may predispose to infection. Methods: Surgical reports and clinical notes were reviewed in 273 consecutive patients who underwent a total of 519 DBS-related procedures in our institute between November 2002 and September 2011. Results: Sixteen separate hardware-related infections occurred in 11 patients. Infections occurred in 3% of all procedures and 4% of all patients. The infection rate after implantable pulse generator (IPG) replacement surgery was more than three times higher than after de novo DBS surgery. In addition, male patients were more likely to develop device-related infections. Conclusions: It is unclear why infection rates should be more than three times higher after IPG replacement surgery than after the de novo procedure. The former is a shorter and simpler procedure to conduct. Perhaps the use of better antimicrobial protection and rechargeable batteries may be useful strategies to reduce infections following IPG revision surgery.

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Surgical and hardware complications in subthalamic nucleus deep brain stimulation

Cited by 34 publications

References 30 publications

An Evaluation of Hardware and Surgical Complications with Deep Brain Stimulation Based on Diagnosis and Lead Location

An Evaluation of Hardware and Surgical Complications with Deep Brain Stimulation Based on Diagnosis and Lead Location

Diagnosis and treatment of complications related to deep brain stimulation hardware

The Risk of Hardware Infection in Deep Brain Stimulation Surgery Is Greater at Impulse Generator Replacement than at the Primary Procedure

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