Avoiding the Common Complications of Deep Brain Stimulation

Surgical Rounds®April 2014

Despite the generally positive history of deep brain stimulation, patients often have preconceptions about the procedure, especially its risks.

Deep brain stimulation (DBS) surgery represents a significant medical achievement for patients with Parkinson’s disease (PD) or other hyperkinetic disorders that are refractory to medication. Despite DBS’s generally positive history, patients often have preconceptions about the procedure, especially its risks.

In a review article on DBS that appeared in the January 2014 issue of the Journal of Neurosurgery, researchers from the Mischer Neuroscience Institute in Texas assessed the incidence of surgical complications both during and after DBS device implantation. Their study population consisted of 728 patients with movement disorders who underwent new DBS device implantation surgery by a single surgeon between 2002 and 2010.

Across 1,356 stereotactic procedures, the patients received 1,333 new DBS electrodes and 1,218 new internal pulse generators (IPGs) for the treatment of movement disorders. Sixty-two percent of study population had PD, while the remaining patients were treated for essential tremor (19.8%), dystonia (8,8%), mixed disease (4.1%), and other hyperkinetic movement disorders (5.2%)

Although severe intraoperative adverse events were rare, they included vasovagal response in 6 patients, hypotension in 2 patients, and seizure in 2 patients. Additionally, 4 patients experienced asymptomatic intracerebral hemorrhage (ICH), 25 had asymptomatic intraventricular hemorrhage, 8 experienced symptomatic ICH, and 3 suffered ischemic infarction. For 13 patients, those events were associated with hemiparesis and/or decreased consciousness.

Eighteen patients developed long-term complications that did not require additional surgery. Of that group, 8 reported hardware discomfort and 10 reported loss of desired effect.

Some patients experienced hardware-related complications that required surgical revision, including wound infections (13 patients), lead malposition and/or migration (13 patients), component fracture (10 patients), component malfunction (4 patients), and loss of effect (19 patients).

The study, which was one of the largest trials on DBS to date, documented that complications secondary to DBS surgery are rare. The authors emphasized the DBS’s relative safety and hoped it encourages more patients to consider the benefits of the procedure.

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