Abstract
Purpose
Deep brain stimulation (DBS) has been established as a safe and efficient method for the treatment of various movement disorders. As the emerging applications continue to expand and more centers become eligible for the procedure, complication rates and complication avoidance become increasingly important. Our aim was to report the DBS-related complication in our department over the last 7 years, compare our rates with those reported in the literature, and highlight those practices that will aid complications avoidance.
Patients and methods
Since 2003, 106 patients underwent DBS for various pathologies in our department. There were 38 (36%) females and 68 (64%) males with a mean age of 57 years. Preoperative diagnoses included Parkinson’s disease (n = 88), dystonia (n = 12), tremor (n = 3), epilepsy (n = 1), obsessive-compulsive disorder (n = 1), and central pain syndrome (n = 1). Surgical and hardware-related complications, their treatment, and outcome were recorded and compared with those reported in the literature.
Results
There were 12 procedure-related complications (11.3% of patients, 5.7% of the procedures). These included death (n = 1), aborted procedure (n = 1), postoperative respiratory distress (n = 3), intracranial hemorrhage (n = 2), epilepsy (n = 1), postoperative confusion or agitation (n = 3), and malignant neuroleptic syndrome (n = 1). Hardware-related complications presented in 4.3% of the procedures and included infection (five patients, 4.7%), electrode breakage (0.94%), lead migration or misplacement (0.94%), and stricture formation (two patients, 1.9%).
Conclusions
Complication rates after DBS surgery remain low, proving that DBS is not only effective but also safe. Certain strategies do exist in order to minimize complications.
Similar content being viewed by others
References
Adnet P, Lestavel P, Krivosic-Horber R (2000) Neuroleptic malignant syndrome. Br J Anaesth 85:129–135
Anderson BJ, Marks PV, Futter ME (1994) Propofol-contrasting effects in movement disorders. Br J Neurosurg 8:387–388
Aziz TZ, Bain PG (1996) A multidisciplinary approach to tremor. Br J Neurosurg 10:435–437
Aziz TZ, Bain PG (1999) Deep brain stimulation in Parkinson's disease. J Neurol Neurosurg Psychiatry 67:281
Benabid AL (2007) What the future holds for deep brain stimulation. Expert Rev Med Devices 4:895–903
Benazzouz A, Breit S, Koudsie A, Pollak P, Krack P, Benabid AL (2002) Intraoperative microrecordings of the subthalamic nucleus in Parkinson's disease. Mov Disord 17(Suppl 3):S145–S149
Beric A, Kelly PJ, Rezai A, Sterio D, Mogilner A, Zonenshayn M, Kopell B (2001) Complications of deep brain stimulation surgery. Stereotact Funct Neurosurg 77:73–78
Binder DK, Rau GM, Starr PA (2005) Risk factors for hemorrhage during microelectrode-guided deep brain stimulator implantation for movement disorders. Neurosurgery 56:722–732, discussion 722–732
Blomstedt P, Hariz MI (2005) Hardware-related complications of deep brain stimulation: a ten year experience. Acta Neurochir (Wien) 147:1061–1064, discussion 1064
Boviatsis EJ, Kouyialis AT, Boutsikakis I, Korfias S, Sakas DE (2004) Infected CNS infusion pumps. Is there a chance for treatment without removal? Acta Neurochir (Wien) 146:463–467
Broggi G, Franzini A, Tringali G, Ferroli P, Marras C, Romito L, Maccagnano E (2006) Deep brain stimulation as a functional scalpel. Acta Neurochir Suppl 99:13–19
Chou YC, Lin SZ, Hsieh WA, Lin SH, Lee CC, Hsin YL, Yen PS, Lee CW, Chiu WT, Chen SY (2007) Surgical and hardware complications in subthalamic nucleus deep brain stimulation. J Clin Neurosci 14:643–649
Constantoyannis C, Berk C, Honey CR, Mendez I, Brownstone RM (2005) Reducing hardware-related complications of deep brain stimulation. Can J Neurol Sci 32:194–200
Deep-Brain Stimulation for Parkinson's Disease Study Group (2001) Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease. N Engl J Med 345:956–963
Ford B, Winfield L, Pullman SL, Frucht SJ, Du Y, Greene P, Cheringal JH, Yu Q, Cote LJ, Fahn S, McKhann GM 2nd, Goodman RR (2004) Subthalamic nucleus stimulation in advanced Parkinson's disease: blinded assessments at one year follow up. J Neurol Neurosurg Psychiatry 75:1255–1259
Funkiewiez A, Ardouin C, Krack P, Fraix V, Van Blercom N, Xie J, Moro E, Benabid AL, Pollak P (2003) Acute psychotropic effects of bilateral subthalamic nucleus stimulation and levodopa in Parkinson's disease. Mov Disord 18:524–530
Goodman RR, Kim B, McClelland S 3rd, Senatus PB, Winfield LM, Pullman SL, Yu Q, Ford B, McKhann GM 2nd (2006) Operative techniques and morbidity with subthalamic nucleus deep brain stimulation in 100 consecutive patients with advanced Parkinson's disease. J Neurol Neurosurg Psychiatry 77:12–17
Haines SJ, Walters BC (1994) Antibiotic prophylaxis for cerebrospinal fluid shunts: a metanalysis. Neurosurgery 34:87–92
Hariz MI (2002) Safety and risk of microelectrode recording in surgery for movement disorders. Stereotact Funct Neurosurg 78:146–157
Hariz MI, Fodstad H (1999) Do microelectrode techniques increase accuracy or decrease risks in pallidotomy and deep brain stimulation? A critical review of the literature. Stereotact Funct Neurosurg 72:157–169
Herzog J, Volkmann J, Krack P, Kopper F, Potter M, Lorenz D, Steinbach M, Klebe S, Hamel W, Schrader B, Weinert D, Muller D, Mehdorn HM, Deuschl G (2003) Two-year follow-up of subthalamic deep brain stimulation in Parkinson's disease. Mov Disord 18:1332–1337
Houeto JL, Mesnage V, Welter ML, Mallet L, Agid Y, Bejjani BP (2003) Subthalamic DBS replaces levodopa in Parkinson's disease: two-year follow-up. Neurology 60:154–155, author reply 154-155
Hutchison WD, Lang AE, Dostrovsky JO, Lozano AM (2003) Pallidal neuronal activity: implications for models of dystonia. Ann Neurol 53:480–488
Iansek R, Rosenfeld JV, Huxham FE (2002) Deep brain stimulation of the subthalamic nucleus in Parkinson's disease. Med J Aust 177:142–146
Jaggi JL, Umemura A, Hurtig HI, Siderowf AD, Colcher A, Stern MB, Baltuch GH (2004) Bilateral stimulation of the subthalamic nucleus in Parkinson's disease: surgical efficacy and prediction of outcome. Stereotact Funct Neurosurg 82:104–114
Joint C, Nandi D, Parkin S, Gregory R, Aziz T (2002) Hardware-related problems of deep brain stimulation. Mov Disord 17(Suppl 3):S175–S180
Kleiner-Fisman G, Fisman DN, Sime E, Saint-Cyr JA, Lozano AM, Lang AE (2003) Long-term follow up of bilateral deep brain stimulation of the subthalamic nucleus in patients with advanced Parkinson disease. J Neurosurg 99:489–495
Kleiner-Fisman G, Herzog J, Fisman DN, Tamma F, Lyons KE, Pahwa R, Lang AE, Deuschl G (2006) Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes. Mov Disord 21(Suppl 14):S290–S304
Kondziolka D, Whiting D, Germanwala A, Oh M (2002) Hardware-related complications after placement of thalamic deep brain stimulator systems. Stereotact Funct Neurosurg 79:228–233
Kouyialis AT, Boviatsis EJ, Ziaka DS, Sakas DE (2007) Use of a single semilinear incision in deep brain stimulation for movement disorders. Acta Neurochir (Wien) 149:501–504, discussion 504
Krause M, Fogel W, Mayer P, Kloss M, Tronnier V (2004) Chronic inhibition of the subthalamic nucleus in Parkinson's disease. J Neurol Sci 219:119–124
Krauss JK, Pohle T, Weber S, Ozdoba C, Burgunder JM (1999) Bilateral stimulation of globus pallidus internus for treatment of cervical dystonia. Lancet 354:837–838
Krauss JK, Yianni J, Loher TJ, Aziz TZ (2004) Deep brain stimulation for dystonia. J Clin Neurophysiol 21:18–30
Lagrange E, Krack P, Moro E, Ardouin C, Van Blercom N, Chabardes S, Benabid AL, Pollak P (2002) Bilateral subthalamic nucleus stimulation improves health-related quality of life in PD. Neurology 59:1976–1978
Lyons KE, Wilkinson SB, Overman J, Pahwa R (2004) Surgical and hardware complications of subthalamic stimulation: a series of 160 procedures. Neurology 63:612–616
Mallet L, Schupbach M, N'Diaye K, Remy P, Bardinet E, Czernecki V, Welter ML, Pelissolo A, Ruberg M, Agid Y, Yelnik J (2007) Stimulation of subterritories of the subthalamic nucleus reveals its role in the integration of the emotional and motor aspects of behavior. Proc Natl Acad Sci USA 104:10661–10666
Masterson TM, Rodeheaver GT, Morgan RF, Edlich RF (1984) Bacteriologic evaluation of electric clippers for surgical hair removal. Am J Surg 148:301–302
Oh MY, Abosch A, Kim SH, Lang AE, Lozano AM (2002) Long-term hardware-related complications of deep brain stimulation. Neurosurgery 50:1268–1274, discussion 1274–1266
Osawa M, Shingu K, Murakawa M, Adachi T, Kurata J, Seo N, Murayama T, Nakao S, Mori K (1994) Effects of sevoflurane on central nervous system electrical activity in cats. Anesth Analg 79:52–57
Ostergaard K, Aa Sunde N (2006) Evolution of Parkinson's disease during 4 years of bilateral deep brain stimulation of the subthalamic nucleus. Mov Disord 21:624–631
Pillon B, Ardouin C, Damier P, Krack P, Houeto JL, Klinger H, Bonnet AM, Pollak P, Benabid AL, Agid Y (2000) Neuropsychological changes between “off” and “on” STN or GPi stimulation in Parkinson's disease. Neurology 55:411–418
Pinsker MO, Volkmann J, Falk D, Herzog J, Steigerwald F, Deuschl G, Mehdorn HM (2009) Deep brain stimulation of the internal globus pallidus in dystonia: target localisation under general anaesthesia. Acta Neurochir (Wien) 151:751–758
Sakas DE, Kouyialis AT, Boviatsis EJ, Panourias IG, Stathis P, Tagaris G (2007) Technical aspects and considerations of deep brain stimulation surgery for movement disorders. Acta Neurochir Suppl 97:163–170
Sakas DE, Panourias IG, Boviatsis EJ, Themistocleous MS, Stavrinou LC, Stathis P, Gatzonis SD (2008) Treatment of idiopathic head drop (camptocephalia) by deep brain stimulation of the globus pallidus internus. J Neurosurg 110:1271–1273
Schwalb JM, Riina HA, Skolnick B, Jaggi JL, Simuni T, Baltuch GH (2001) Revision of deep brain stimulator for tremor. Technical note. J Neurosurg 94:1010–1012
Sillay KA, Larson PS, Starr PA (2008) Deep brain stimulator hardware-related infections: incidence and management in a large series. Neurosurgery 62:360–366, discussion 366–367
Simuni T, Jaggi JL, Mulholland H, Hurtig HI, Colcher A, Siderowf AD, Ravina B, Skolnick BE, Goldstein R, Stern MB, Baltuch GH (2002) Bilateral stimulation of the subthalamic nucleus in patients with Parkinson disease: a study of efficacy and safety. J Neurosurg 96:666–672
Simuni T, Lyons KE, Pahwa R, Hauser RA, Comella C, Elmer L, Weintraub D (2009) Treatment of early Parkinson's disease. Part 1. Eur Neurol 61:193–205
Tamma F, Rampini P, Egidi M, Caputo E, Locatelli M, Pesenti A, Chiesa V, Ardolino G, Foffani G, Meda B, Pellegrini M, Priori A (2003) Deep brain stimulation for Parkinson's disease: the experience of the Policlinico-San Paolo Group in Milan. Neurol Sci 24(Suppl 1):S41–S42
Tavella A, Bergamasco B, Bosticco E, Lanotte M, Perozzo P, Rizzone M, Torre E, Lopiano L (2002) Deep brain stimulation of the subthalamic nucleus in Parkinson's disease: long-term follow-up. Neurol Sci 23(Suppl 2):S111–S112
Temel Y, Ackermans L, Celik H, Spincemaille GH, van der Linden C, Walenkamp GH, van de Kar T, Visser-Vandewalle V (2004) Management of hardware infections following deep brain stimulation. Acta Neurochir (Wien) 146:355–361, discussion 361
Temel Y, Wilbrink P, Duits A, Boon P, Tromp S, Ackermans L, van Kranen-Mastenbroek V, Weber W, Visser-Vandewalle V (2007) Single electrode and multiple electrode guided electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease. Neurosurgery 61:346–355, discussion 355–347
Thobois S, Mertens P, Guenot M, Hermier M, Mollion H, Bouvard M, Chazot G, Broussolle E, Sindou M (2002) Subthalamic nucleus stimulation in Parkinson's disease: clinical evaluation of 18 patients. J Neurol 249:529–534
Umemura A, Jaggi JL, Hurtig HI, Siderowf AD, Colcher A, Stern MB, Baltuch GH (2003) Deep brain stimulation for movement disorders: morbidity and mortality in 109 patients. J Neurosurg 98:779–784
Valldeoriola F, Pilleri M, Tolosa E, Molinuevo JL, Rumia J, Ferrer E (2002) Bilateral subthalamic stimulation monotherapy in advanced Parkinson's disease: long-term follow-up of patients. Mov Disord 17:125–132
Vesper J, Klostermann F, Stockhammer F, Funk T, Brock M (2002) Results of chronic subthalamic nucleus stimulation for Parkinson's disease: a 1-year follow-up study. Surg Neurol 57:306–311, discussion 311–303
Vingerhoets FJ, Villemure JG, Temperli P, Pollo C, Pralong E, Ghika J (2002) Subthalamic DBS replaces levodopa in Parkinson's disease: two-year follow-up. Neurology 58:396–401
Voges J, Waerzeggers Y, Maarouf M, Lehrke R, Koulousakis A, Lenartz D, Sturm V (2006) Deep-brain stimulation: long-term analysis of complications caused by hardware and surgery—experiences from a single centre. J Neurol Neurosurg Psychiatry 77:868–872
Volkmann J, Allert N, Voges J, Weiss PH, Freund HJ, Sturm V (2001) Safety and efficacy of pallidal or subthalamic nucleus stimulation in advanced PD. Neurology 56:548–551
Financial disclosure/conflict of interest
No financial support provided. No conflicts of interest are present.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Boviatsis, E.J., Stavrinou, L.C., Themistocleous, M. et al. Surgical and hardware complications of deep brain stimulation. A seven-year experience and review of the literature. Acta Neurochir 152, 2053–2062 (2010). https://doi.org/10.1007/s00701-010-0749-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-010-0749-8