DBS Revision Surgery: Indications and Nuances

  • David Shin
  • Justin D. Hilliard
  • Kelly D. Foote


Deep brain stimulation surgery has become the treatment of choice for appropriately selected patients with Parkinson’s disease, essential tremor, and dystonia. Despite the significant risk associated with minimally invasive brain surgery, the risk-to-benefit ratio for DBS surgery is quite favorable, and the overwhelming majority of patients derive substantial improvement in their motor function and quality of life from well-executed DBS therapy. A nonnegligible number of movement disorders patients, however, report unsatisfactory outcomes after DBS surgery. If we define “DBS failure as any case in which the patient and her/his caregivers are dissatisfied with the outcome of DBS surgery, then potential causes of DBS failure include failure to set appropriate expectations preoperatively, inappropriate patient selection, failures of postoperative device programming and medical management, in addition to various surgical and device-related complications including suboptimal lead placement, hardware failures, and rare instances of procedure-related brain injury resulting in permanent neurologic impairment. In this chapter, we focus on the various causes of DBS failure that are potentially correctable through surgical intervention. We review methods for evaluating patients presenting with DBS failure to identify appropriate candidates for various surgical salvage procedures, and we present successful decision-making strategies and surgical techniques for carrying out these operations.


  1. 1.
    Okun MS, Tagliati M, Pourfar M, Fernandez HH, Rodriguez RL, Alterman RL, et al. Management of referred deep brain stimulation failures: a retrospective analysis from 2 movement disorders centers. Arch Neurol. 2005;62:1250–5.CrossRefGoogle Scholar
  2. 2.
    Ellis TM, Foote KD, Fernandez HH, Sudhyadhom A, Rodriguez RL, Zeilman P, et al. Reoperation for suboptimal outcomes after deep brain stimulation surgery. Neurosurgery. 2008;63:754–60 discussion 760-751.CrossRefGoogle Scholar
  3. 3.
    Falowski SM, Ooi YC, Bakay RA. Long-term evaluation of changes in operative technique and hardware-related complications with deep brain stimulation. Neuromodulation. 2015;18(8):670–7.CrossRefGoogle Scholar
  4. 4.
    Guridi J, Rodriguez-Oroz MC, Alegre M, Obeso JA. Hardware complications in deep brain stimulation: electrode impedance and loss of clinical benefit. Parkinsonism Relat Disord. 2012;18:765–9.CrossRefGoogle Scholar
  5. 5.
    Morishita T, Foote KD, Burdick AP, Katayama Y, Yamamoto T, Frucht SJ, Okun MS. Identification and management of deep brain stimulation intra- and postoperative urgencies and emergencies. Parkinsonism Relat Disord. 2010;16:153–62.CrossRefGoogle Scholar
  6. 6.
    Troche MS, Brandimore AE, Foote KD, Okun MS. Swallowing and deep brain stimulation in Parkinson’s disease: a systematic review. Parkinsonism Relat Disord. 2013;19:783–8.CrossRefGoogle Scholar
  7. 7.
    Matias CM, Silva D, Machado AG, Cooper SE. Rescue of bilateral subthalamic stimulation by bilateral pallidal stimulation: case report. J Neurosurg. 2016;124(2):417–21.Google Scholar
  8. 8.
    Oyama G, Foote KD, Hwynn N, Jacobson CE, Malaty IA, Rodriguez RL, et al. Rescue leads: a salvage technique for selected patients with a suboptimal response to standard DBS therapy. Parkinsonism Relat Disord. 2011;17:451–5.CrossRefGoogle Scholar
  9. 9.
    Oyama G, Maling N, Avila-Thompson A, Zeilman PR, Foote KD, Malaty IA, Rodriguez RL, Okun MS. Rescue GPi-DBS for a stroke-associated hemiballism in a patient with STN-DBS. Tremor Other Hyperkinet Mov (N Y). 2014;4:tre-04-214-4855-1. eCollection 2014.
  10. 10.
    Alex Mohit A, Samii A, Slimp JC, Grady MS, Goodkin R. Mechanical failure of the electrode wire in deep brain stimulation. Parkinsonism Relat Disord. 2004;10:153–6.CrossRefGoogle Scholar
  11. 11.
    Fernandez FS, Alvarez Vega MA, Antuna Ramos A, Fernandez Gonzalez F, Lozano Aragoneses B. Lead fractures in deep brain stimulation during long-term follow-up. Parkinsons Dis. 2010;2010:409356.PubMedGoogle Scholar
  12. 12.
    Yianni J, Nandi D, Shad A, Bain P, Gregory R, Aziz T. Increased risk of lead fracture and migration in dystonia compared with other movement disorders following deep brain stimulation. J Clin Neurosci. 2004;11:243–5.CrossRefGoogle Scholar
  13. 13.
    Bayliss CE, Beanlands DS, Baird RJ. The pacemaker-twiddler’s syndrome: a new complication of implantable transvenous pacemakers. Can Med Assoc J. 1968;99:371–3.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Astradsson A, Schweder PM, Joint C, Green AL, Aziz TZ. Twiddler’s syndrome in a patient with a deep brain stimulation device for generalized dystonia. J Clin Neurosci. 2011;18:970–2.CrossRefGoogle Scholar
  15. 15.
    Gelabert-Gonzalez M, Relova-Quinteiro J-L, Castro-García A. “Twiddler syndrome” in two patients with deep brain stimulation. Acta Neurochir. 2010;152:489–91.CrossRefGoogle Scholar
  16. 16.
    Machado AG, Hiremath GK, Salazar F, Rezai AR. Fracture of subthalamic nucleus deep brain stimulation hardware as a result of compulsive manipulation: case report. Neurosurgery. 2005;57:E1318.CrossRefGoogle Scholar
  17. 17.
    Sudhyadhom A, Haq IU, Foote KD, Okun MS, Bova FJ. A high resolution and high contrast MRI for differentiation of subcortical structures for DBS targeting: the Fast Gray Matter Acquisition T1 Inversion Recovery (FGATIR). Neuroimage. 2009;47(Suppl 2):T44–52.CrossRefGoogle Scholar
  18. 18.
    Allert N, Schnitzler A, Sturm V, Maarouf M. Failure of long-term subthalamic nucleus stimulation corrected by additional pallidal stimulation in a patient with Parkinson's disease. J Neurol. 2012;259:1244–6.CrossRefGoogle Scholar
  19. 19.
    Minafra B, Fasano A, Pozzi NG, Zangaglia R, Servello D, Pacchetti C. Eight-years failure of subthalamic stimulation rescued by globus pallidus implant. Brain Stimul. 2014;7:179–81.CrossRefGoogle Scholar
  20. 20.
    Peppe A, Pierantozzi M, Bassi A, Altibrandi MG, Brusa L, Stefani A, et al. Stimulation of the subthalamic nucleus compared with the globus pallidus internus in patients with Parkinson disease. J Neurosurg. 2004;101:195–200.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • David Shin
    • 1
  • Justin D. Hilliard
    • 1
  • Kelly D. Foote
    • 1
  1. 1.University of Florida, Department of NeurosurgeryGainesvilleUSA

Personalised recommendations