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Surgical adverse events of deep brain stimulation in the subthalamic nucleus of patients with Parkinson’s disease. The learning curve and the pitfalls

  • Clinical Article - Functional
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Abstract

Background

Several surgical adverse events (SAEs) have been associated with Deep Brain Stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson’s Disease (PD) patients, leading to certain confusion about the risk/benefit ratio of this technique, and giving rise to the need of more and more extensive control studies over longer periods. The aim of this article is to identify and quantify the factors associated with the most frequent AEs from STN DBS in PD-diagnosed patients.

Methods

The following variables were studied: aborted procedure, misplaced leads, intracranial haemorrhage, and seizures. This study was carried out in 233 patients diagnosed with PD, with 455 STN electrodes implanted and follow-up after 7 (8–14) years follow up.

Results

A total amount of 56 SAEs occurred in 49 patients (11.76 % of total procedures, 12.31 % of implanted leads, 21.03 % of patients). SAEs were: five aborted procedures, 26 misplaced leads, ten intracranial haemorrhages, and 15 seizures. Of all the SAEs, long-term effects only happened in two cases of hemiparesis caused by intracranial haemorrhage; the other SAEs were reversible and didn’t leave any long-term clinical consequences (0.42 % of procedures, 0.44 % of leads, and 0.86 % of patients).

Conclusions

STN DBS in PD patients is a safe surgical procedure, with good risk/benefit ratios: procedure reliability/correct lead implantation in 95.59 %, 0 mortality/implanted lead, 0.12 morbidity/implanted lead, and 0.0043 neurological sequelae/implanted lead.

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Authors and Affiliations

  1. Neurosurgery Department, Central University Hospital of Asturias, Celestino Villamil, s/n., 33006, Oviedo, Spain

    Fernando Seijo, Sayoa Alvarez de Eulate Beramendi, Ramón Fernández de León & Marco Antonio Alvarez Vega

  2. Radiology Department, Central University Hospital of Asturias, Oviedo, Spain

    Elena Santamarta Liébana & Antonio Saiz Ayala

  3. Neurophysiology Department, Central University Hospital of Asturias, Oviedo, Spain

    Beatriz Lozano Aragoneses

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  1. Fernando Seijo
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  2. Sayoa Alvarez de Eulate Beramendi
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  5. Antonio Saiz Ayala
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  6. Ramón Fernández de León
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  7. Marco Antonio Alvarez Vega
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Corresponding author

Correspondence to Marco Antonio Alvarez Vega.

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Comments

Complications following Deep brain stimulation (DBS) surgery are relatively common and are generally either procedural related or hardware related.

Procedura; complications such as ICH, electrode misplacement, aborted procedures etc are closely related with the overall volume of cases done and have a clear relation with the single surgeon learning curve. Procedural complications are less common in high volume centre where there is a well-established DBS program; the authors clearly stated this point in their discussion. Is there a minimal volume of DBS procedure per year that make a centre safe on the procedural point of view ? In the UK a minimum of 10 DBS per year has been considered the cut off number to receive accreditation, I still consider this number too low, possibly 35-50 DBS procedures are the number that a DBS centre should be performing to minimize procedural risks.

Another important issue is infection in DBS which can be either associated with the implantation or with the hardware revisions.

Reduction of infections could be achieved with antibiotics impregnated hardware (as has been developed for shunt hardware) and close collaboration with the manufacture is necessary to improve the infection profile of DBS.

In this interesting paper the authors reported a relatively high rate of ICH, is this possibly associated with MER and multiple trajectories. The jury is still out regarding the necessity of MER but there is definitively an increased risk with this technique. Delayed ICH/strokes are potentially devastating complications and as for brain biopsies can occur in DBS, early post-operative CT may give a false sense of security.

The functional neurosurgical community should work harder to reduce the rate of complications both procedural and hardware related, in the future national and international registry will allow to identify potential solvable problems in DBS surgery.

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Jibril Osman Farah

Liverpool, UK

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Seijo, F., Alvarez de Eulate Beramendi, S., Santamarta Liébana, E. et al. Surgical adverse events of deep brain stimulation in the subthalamic nucleus of patients with Parkinson’s disease. The learning curve and the pitfalls. Acta Neurochir 156, 1505–1512 (2014). https://doi.org/10.1007/s00701-014-2082-0

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  • DOI: https://doi.org/10.1007/s00701-014-2082-0

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