Surgical and Hardware Complications of Deep Brain Stimulation—A Single Surgeon Experience of 519 Cases Over 20 Years

Doshi, Paresh K; Rai, Neha; Das, Deepak

doi:10.1111/ner.13360

Cited by 21 publications

(15 citation statements)

References 39 publications

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“… Hariz and De Salles (1997) also found a permanent complication rate of 10% in their series. When we compared the results with our DBS series, the surgical complications were seen in 8.9% of the patients and hardware complications in an additional 5% of the patients, which are higher than the lesional surgeries ( Doshi et al, 2021 ). Blomstedt and Hariz (2006) found perioperative complication rate to be the same in the patients undergoing DBS or lesional procedure.…”

Section: Discussionmentioning

confidence: 98%

“…However, as mentioned earlier, our mortality in patients with pallidotomy was in the very early period of our experience, which we subsequently corrected and avoided any further mortality. There is a learning curve for all procedures and the complications decrease as the experience increases ( Doshi et al, 2021 ). We had the most complications in the first 10 years of our practice when we had 67% of the complications.…”

Section: Discussionmentioning

confidence: 99%

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Radiofrequency Lesioning for Movement and Psychiatric Disorders-Experience of 107 Cases

Doshi

2021

Front. Hum. Neurosci.

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BackgroundRadiofrequency lesioning (RFL) though used since the 1950s, had been replaced by DBS in the 1990s. The availability of magnetic resonance-guided focused ultrasound for lesioning has renewed the interest in RFL.ObjectiveThis paper analysis RFL in contemporary Functional Neurosurgery for various indications and its outcome. Complication rates of RFL are compared with the same author’s experience of DBS.MethodsOne hundred and seven patients underwent RFL between 1998 and 2019. Indications included Parkinson’s Disease (PD), tremors, dystonia, and obsessive-compulsive disorders (OCD). The surgeries performed include thalamotomy (29), pallidotomy (49), subthalamotomy (23), and anterior capsulotomy/nucleus accumbens lesioning (6). Appropriate rating scales were used for preoperative and postoperative evaluations.ResultsThere was a 25% recurrence rate of tremors for PD after thalamotomy. Writer’s cramp rating scale improved from a mean of 10.54–1.6 in task specific dystonia (TSD) patients, after thalamotomy. In PD patients, after pallidotomy, contralateral motor Unified Parkinson’s Disease Rating Scale (UPDRS) and dyskinesia scores, improved by 41 and 57%, respectively, at 1-year. Burke-Fahn-Marsden Dystonia Rating Scale in hemidystonia patients improved from 18.04 to 6.91, at 1-year. There was 32 and 31% improvement in total and motor UPDRS, respectively, in the subthalamotomy patients, at 2-year. All patients of OCD were in remission. There were three deaths in the pallidotomy group. Postoperative, dysarthria, confusion, hemiparesis, dyskinesia, and paraesthesia occurred in 12 patients, of which, 7 were transient.ConclusionRFL is a useful option in a select group of patients with tremors and dystonia. It is our preferred treatment option for TSD and OCD.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Radiofrequency Lesioning for Movement and Psychiatric Disorders-Experience of 107 Cases

Doshi

2021

Front. Hum. Neurosci.

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“…In addition, infection is a common complication of DBS. 20 Detection of a large area of low‐density shadow on CT may be considered as an infection. However, PLE after DBS operation may also present similarly in CT imaging, and this may further explain the underreporting of PLE.…”

Section: Discussionmentioning

confidence: 99%

The need to be alert to complications of peri‐lead cerebral edema caused by deep brain stimulation implantation: A systematic literature review and meta‐analysis study

Wang

Jiang

et al. 2022

CNS Neurosci Ther

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“…9,10 However, patient-or surgery-related factors associated with and the management of surgical and hardwarerelated AEs of DBS are not frequently described. [11][12][13][14] In light of increased application of DBS in established and emerging indications and substantial resources required for DBS (ie, extensive programming, lifelong follow-up, and recurrent hardware costs), reporting current surgical and hardware-related AEs is essential for evaluating the risk-benefit ratio of this therapy. Here, we present a comprehensive analysis of the AEs that occurred following DBS-associated surgical procedures over a period of ten years in a single center.…”

Section: Introductionmentioning

confidence: 99%

Surgical and Hardware-Related Adverse Events of Deep Brain Stimulation: A Ten-Year Single-Center Experience

Vlis

Veerdonk

Ackermans

et al. 2022

Neuromodulation: Technology at the Neural Interface

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Introduction: Although deep brain stimulation (DBS) is effective for treating a number of neurological and psychiatric indications, surgical and hardware-related adverse events (AEs) can occur that affect quality of life. This study aimed to give an overview of the nature and frequency of those AEs in our center and to describe the way they were managed. Furthermore, an attempt was made at identifying possible risk factors for AEs to inform possible future preventive measures.Materials and Methods: Patients undergoing DBS-related procedures between January 2011 and July 2020 were retrospectively analyzed to inventory AEs. The mean follow-up time was 43 ± 31 months. Univariate logistic regression analysis was used to assess the predictive value of selected demographic and clinical variables.Results: From January 2011 to July 2020, 508 DBS-related procedures were performed including 201 implantations of brain electrodes in 200 patients and 307 implantable pulse generator (IPG) replacements in 142 patients. Surgical or hardware-related AEs following initial implantation affected 40 of 200 patients (20%) and resolved without permanent sequelae in all instances. The most frequent AEs were surgical site infections (SSIs) (9.95%, 20/201) and wire tethering (2.49%, 5/201), followed by hardware failure (1.99%, 4/201), skin erosion (1.0%, 2/201), pain (0.5%, 1/201), lead migration (0.52%, 2/386 electrode sites), and hematoma (0.52%, 2/386 electrode sites). The overall rate of AEs for IPG replacement was 5.6% (17/305). No surgical, ie, staged or nonstaged, electrode fixation, or patient-related risk factors were identified for SSI or wire tethering.Conclusions: Major AEs including intracranial surgery-related AEs or AEs requiring surgical removal or revision of hardware are rare. In particular, aggressive treatment is required in SSIs involving multiple sites or when Staphylococcus aureus is identified. For future benchmarking, the development of a uniform reporting system for surgical and hardware-related AEs in DBS surgery would be useful.

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Surgical and Hardware Complications of Deep Brain Stimulation—A Single Surgeon Experience of 519 Cases Over 20 Years

Cited by 21 publications

References 39 publications

Radiofrequency Lesioning for Movement and Psychiatric Disorders-Experience of 107 Cases

Radiofrequency Lesioning for Movement and Psychiatric Disorders-Experience of 107 Cases

The need to be alert to complications of peri‐lead cerebral edema caused by deep brain stimulation implantation: A systematic literature review and meta‐analysis study

Surgical and Hardware-Related Adverse Events of Deep Brain Stimulation: A Ten-Year Single-Center Experience

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