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Analysis of hemorrhagic risk factors during deep brain stimulation surgery for movement disorders: comparison of the circumferential paired and multiple electrode insertion methods

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Abstract

Background

The most serious complication of deep brain stimulation (DBS) surgery is intracranial hemorrhage. The authors have assessed risk factors for hemorrhage in DBS surgery and compared two types of microelectrode insertion technique on hemorrhagic risk.

Methods

A total of 171 DBS procedures were performed on 110 patients (58 females, 52 males) by the same neurosurgeon at a single center between May 2005 and May 2010. We used two microelectrode insertion methods: multiple microelectrode insertion (MMI) and circumferential paired microelectrode insertion (CPMI). We analyzed the correlation between bleeding rates and gender, age, hypertension, target location, simultaneous bilateral procedure and electrode insertion method.

Results

Of the 171 DBS procedures, 138 were on 85 patients with Parkinson’s disease, 16 were in 15 patients with essential tremor and 17 were on ten patients with dystonia. There were nine postoperative hemorrhagic events (5.26%), of which three were symptomatic (1.75%), and one permanent neurological deficit event (0.58%). Compared with the bleeding rate in the MMI method (9/106, 8.5%), there was no instance of bleeding with the CPMI method (0/65, 0%) (p = 0.04). In other factors, the correlation with hemorrhage was not found.

Conclusion

Use of the CPMI method significantly decreased the rate of bleeding. This new surgical technique seems to be safe and accurate and may be recommended as another surgical option.

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References

  1. Ben-Haim S, Asaad WF, Gale JT, Eskandar EN (2009) Risk factors for hemorrhage during microelectrode-guided deep brain stimulation and the introduction of an improved microelectrode design. Neurosurgery 64:754–762, discussion 762–753

    Article  PubMed  Google Scholar 

  2. Binder DK, Rau G, Starr PA (2004) Hemorrhagic complications of microelectrode-guided deep brain stimulation. Stereotact Funct Neurosurg 80:28–31

    Article  Google Scholar 

  3. 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

    Article  PubMed  Google Scholar 

  4. Chan DTM, Zhu XL, Yeung JHM, Mok VCT, Wong E, Lau C, Wong R, Lau C, Poon WS (2009) Complications of deep brain stimulation: a collective review. Asian J Surg 32:258–263

    Article  PubMed  Google Scholar 

  5. Gorgulho A, De Salles AA, Frighetto L, Behnke E (2005) Incidence of hemorrhage associated with electrophysiological studies performed using macroelectrodes and microelectrodes in functional neurosurgery. J Neurosurg 102:888–896

    Article  PubMed  Google Scholar 

  6. Kenney C, Simpson R, Hunter C, Ondo W, Almaguer M, Davidson A, Jankovic J (2007) Short-term and long-term safety of deep brain stimulation in the treatment of movement disorders. J Neurosurg 106:621–625

    Article  PubMed  Google Scholar 

  7. Krack P, Batir A, Van Blercom N, Chabardes S, Fraix V, Ardouin C, Koudsie A, Limousin PD, Benazzouz A, LeBas JF, Benabid AL, Pollak P (2003) Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 349:1925–1934

    Article  PubMed  CAS  Google Scholar 

  8. Kupsch A, Kuehn A, Klaffke S, Meissner W, Harnack D, Winter C, Haelbig TD, Kivi A, Arnold G, Einhaupl KM, Schneider GH, Trottenberg T (2003) Deep brain stimulation in dystonia. J Neurol 250(Suppl 1):I47–I52

    PubMed  Google Scholar 

  9. Sansur CA, Frysinger RC, Pouratian N, Fu KM, Bittl M, Oskouian RJ, Laws ER, Elias WJ (2007) Incidence of symptomatic hemorrhage after stereotactic electrode placement. J Neurosurg 107:998–1003

    Article  PubMed  Google Scholar 

  10. Seijo FJ, Alvarez-Vega MA, Gutierrez JC, Fdez-Glez F, Lozano B (2007) Complications in subthalamic nucleus stimulation surgery for treatment of Parkinson’s disease. Review of 272 procedures. Acta Neurochir Wien 149:867–875, discussion 876

    Article  PubMed  CAS  Google Scholar 

  11. The 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

    Article  Google Scholar 

  12. Vaillancourt DE, Sturman MM, Verhagen Metman L, Bakay RA, Corcos DM (2003) Deep brain stimulation of the VIM thalamic nucleus modifies several features of essential tremor. Neurology 61:919–925

    PubMed  CAS  Google Scholar 

  13. Vesper J, Haak S, Ostertag C, Nikkhah G (2007) Subthalamic nucleus deep brain stimulation in elderly patients—analysis of outcome and complications. BMC Neurol 7:7

    Article  PubMed  Google Scholar 

  14. 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

    Article  PubMed  CAS  Google Scholar 

  15. Xiaowu H, Xiufeng J, Xiaoping Z, Bin H, Laixing W, Yiqun C, Jinchuan L, Aiguo J, Jianmin L (2010) Risks of intracranial hemorrhage in patients with Parkinson's disease receiving deep brain stimulation and ablation. Parkinsonism Relat Disord 16:96–100

    Article  PubMed  Google Scholar 

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Acknowledgements

This paper was supported by KRCF National Agenda Project.

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Correspondence to Sang Ryong Jeon.

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Park, J.H., Chung, S.J., Lee, C.S. et al. Analysis of hemorrhagic risk factors during deep brain stimulation surgery for movement disorders: comparison of the circumferential paired and multiple electrode insertion methods. Acta Neurochir 153, 1573–1578 (2011). https://doi.org/10.1007/s00701-011-0997-2

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  • DOI: https://doi.org/10.1007/s00701-011-0997-2

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