Complications of deep brain stimulation in Parkinson's disease: a single-center experience of 517 consecutive cases.
Deep brain stimulation
Hardware failure
Intracerebral hemorrhage
Parkinson’s disease
Surgical complications: Movement disorder
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
11 2023
11 2023
Historique:
received:
11
06
2023
accepted:
03
09
2023
medline:
6
11
2023
pubmed:
29
9
2023
entrez:
29
9
2023
Statut:
ppublish
Résumé
The number of deep brain stimulation (DBS) procedures is rapidly rising as well as the novel indications. Reporting adverse events related to surgery and to the hardware used is essential to define the risk-to-benefit ratio and develop novel strategies to improve it. To analyze DBS complications (both procedure-related and hardware-related) and further assess potential predictive factors. Five hundred seventeen cases of DBS for Parkinson's disease were performed between 2006 and 2021 in a single center (mean follow-up: 4.68 ± 2.86 years). Spearman's Rho coefficient was calculated to search for a correlation between the occurrence of intracerebral hemorrhage (ICH) and the number of recording tracks. Multiple logistic regression analyzed the probability of developing seizures and ICH given potential risk factors. Kaplan-Meier curves were performed to analyze the cumulative proportions of hardware-related complications. Mortality rate was 0.2%, while permanent morbidity 0.6%. 2.5% of cases suffered from ICH which were not influenced by the number of tracks used for recordings. 3.3% reported seizures that were significantly affected by perielectrode brain edema and age. The rate of perielectrode brain edema was significantly higher for Medtronic's leads compared to Boston Scientific's (Χ Overall DBS has to be considered a safe procedure, but future research is needed to decrease the rate of hardware-related complications which may be related to both the surgical technique and to the specific hardware's design. The increased incidence of perielectrode brain edema associated with certain lead models may likewise deserve future investigation.
Sections du résumé
BACKGROUND
The number of deep brain stimulation (DBS) procedures is rapidly rising as well as the novel indications. Reporting adverse events related to surgery and to the hardware used is essential to define the risk-to-benefit ratio and develop novel strategies to improve it.
OBJECTIVE
To analyze DBS complications (both procedure-related and hardware-related) and further assess potential predictive factors.
METHODS
Five hundred seventeen cases of DBS for Parkinson's disease were performed between 2006 and 2021 in a single center (mean follow-up: 4.68 ± 2.86 years). Spearman's Rho coefficient was calculated to search for a correlation between the occurrence of intracerebral hemorrhage (ICH) and the number of recording tracks. Multiple logistic regression analyzed the probability of developing seizures and ICH given potential risk factors. Kaplan-Meier curves were performed to analyze the cumulative proportions of hardware-related complications.
RESULTS
Mortality rate was 0.2%, while permanent morbidity 0.6%. 2.5% of cases suffered from ICH which were not influenced by the number of tracks used for recordings. 3.3% reported seizures that were significantly affected by perielectrode brain edema and age. The rate of perielectrode brain edema was significantly higher for Medtronic's leads compared to Boston Scientific's (Χ
CONCLUSION
Overall DBS has to be considered a safe procedure, but future research is needed to decrease the rate of hardware-related complications which may be related to both the surgical technique and to the specific hardware's design. The increased incidence of perielectrode brain edema associated with certain lead models may likewise deserve future investigation.
Identifiants
pubmed: 37773459
doi: 10.1007/s00701-023-05799-w
pii: 10.1007/s00701-023-05799-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3385-3396Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.
Références
Alfonso F, Ibañez L, Hem S, Ajler P, Vecchi E, Ciraolo C, Baccanelli M, Tramontano R, Knezevich F, Carrizo A (2011) A new classification of complications in neurosurgery. WNEU 75:709–715
Atchley TJ, Elsayed GA, Sowers B, Walker HC, Chagoya G, Davis MC, Bernstock JD, Omar NB, Patel DM, Guthrie BL (2020) Incidence and risk factors for seizures associated with deep brain stimulation surgery. J Neurosurg 135(1):279–283
doi: 10.3171/2020.5.JNS20125
pubmed: 32764176
Azmi H, MacHado A, Deogaonkar M, Rezai A (2011) Intracranial air correlates with preoperative cerebral atrophy and stereotactic error during bilateral STN DBS surgery for Parkinson’s disease. Stereotact Funct Neurosurg 89(4):246–252
doi: 10.1159/000327916
pubmed: 21778795
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(1–4):73–78
doi: 10.1159/000064600
pubmed: 12378060
Bhatia S, Oh M, Whiting T, Quigley M, Whiting D (2008) Surgical complications of deep brain stimulation. A longitudinal single surgeon, single institution study. Stereotact Funct Neurosurg 86(6):367–372. https://doi.org/10.1159/000175799
doi: 10.1159/000175799
pubmed: 19033705
Binder DK, Rau GM, Starr PA (2005) Risk factors for hemorrhage during microelectrode-guided deep brain stimulator implantation for movement disorders. Neurosurgery 56(4):722–728
doi: 10.1227/01.NEU.0000156473.57196.7E
pubmed: 15792511
Blomstedt P, Hariz MI (2005) Hardware-related complications of deep brain stimulation: a ten year experience. Acta Neurochir (Wien) 147(10):1061–1064
doi: 10.1007/s00701-005-0576-5
pubmed: 16041470
Boviatsis EJ, Stavrinou LC, Themistocleous M, Kouyialis AT, Sakas DE (2010) Surgical and hardware complications of deep brain stimulation. A seven-year experience and review of the literature. Acta Neurochir (Wien) 152(12):2053–2062
doi: 10.1007/s00701-010-0749-8
pubmed: 20658301
Brandmeir N, Nehrbass E, McInerney J (2016) An analysis of scalp thickness and other novel risk factors for deep brain stimulator infections. Cureus 8(9):e792. https://doi.org/10.7759/CUREUS.792
doi: 10.7759/CUREUS.792
pubmed: 27774360
pmcid: 5072663
Burchiel KJ, McCartney S, Lee A, Raslan AM (2013) Accuracy of deep brain stimulation electrode placement using intraoperative computed tomography without microelectrode recording. J Neurosurg 119(2):301–306
doi: 10.3171/2013.4.JNS122324
pubmed: 23724986
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(4):258–263. https://doi.org/10.1016/S1015-9584(09)60404-8
doi: 10.1016/S1015-9584(09)60404-8
pubmed: 19892631
Coley E, Farhadi R, Lewis S, Whittle IR (2009) The incidence of seizures following deep brain stimulating electrode implantation for movement disorders, pain and psychiatric conditions. Br J Neurosurg 23(2):179–183. https://doi.org/10.1080/02688690802673197
doi: 10.1080/02688690802673197
pubmed: 19306174
Constantoyannis C, Berk C, Honey CR, Mendez I, Brownstone RM (2005) Reducing hardware-related complications of deep brain stimulation. Can J Neurol Sci 32(2):194–200. https://doi.org/10.1017/s0317167100003966
doi: 10.1017/s0317167100003966
pubmed: 16018154
Falowski SM, Ooi YC, Bakay RAE (2015) Long-term evaluation of changes in operative technique and hardware-related complications with deep brain stimulation. Neuromodulation 18(8):670–676. https://doi.org/10.1111/ner.12335
doi: 10.1111/ner.12335
pubmed: 26245633
Fenoy AJ, Simpson RK (2014) Risks of common complications in deep brain stimulation surgery: management and avoidance. J Neurosurg 120(1):132–139
doi: 10.3171/2013.10.JNS131225
pubmed: 24236657
Gologorsky Y, Ben-Haim S, Moshier EL, Godbold J, Tagliati M, Weisz D, Alterman RL (2011) Transgressing the ventricular wall during subthalamic deep brain stimulation surgery for Parkinson disease increases the risk of adverse neurological sequelae. Neurosurgery 69(2):294–299
doi: 10.1227/NEU.0b013e318214abda
pubmed: 21389886
Gorgulho A, de Salles AAF, Frighetto L, Behnke E (2005) Incidence of hemorrhage associated with electrophysiological studies performed using macroelectrodes and microelectrodes in functional neurosurgery. J Neurosurg 102(5):888–896
doi: 10.3171/jns.2005.102.5.0888
pubmed: 15926715
Halpern CH, Danish SF, Baltuch GH, Jaggi JL (2008) Brain shift during deep brain stimulation surgery for Parkinson’s disease. Stereotact Funct Neurosurg 86(1):37–43
doi: 10.1159/000108587
pubmed: 17881887
Hamani C, Richter E, Schwalb JM, Lozano AM (2005) Bilateral subthalamic nucleus stimulation for Parkinson’s disease: a systematic review of the clinical literature. Neurosurgery 56(6):1313–1321
doi: 10.1227/01.NEU.0000159714.28232.C4
pubmed: 15918948
Hariz MI (2002) Complications of deep brain stimulation surgery. Movement Disorders. https://doi.org/10.1002/mds.10159
Iess G, Bonomo G, Neurologico I, Besta C, Levi V, Aquino D, Zekaj E, Galeazzi IO, Mezza F, Servello D (2022) MER use and prolonged surgical duration may not be risk factors for pneumocephalus formation during DBS. https://doi.org/10.21203/rs.3.rs-1300749/v1
doi: 10.21203/rs.3.rs-1300749/v1
Jackson KL, Devine JG (2016) The effects of smoking and smoking cessation on spine surgery: a systematic review of the literature. Global Spine J 6(7):695–701. https://doi.org/10.1055/s-0036-1571285
doi: 10.1055/s-0036-1571285
pubmed: 27781190
pmcid: 5077710
Kantzanou M, Korfias S, Panourias I, Sakas DE, Karalexi MA (2021) Deep brain stimulation-related surgical site infections: a systematic review and meta-analysis. Neuromodulation 24(2):197–211
doi: 10.1111/ner.13354
pubmed: 33462954
Kozai TDY, Jaquins-Gerstl AS, Vazquez AL, Michael AC, Cui XT (2015) Brain tissue responses to neural implants impact signal sensitivity and intervention strategies. ACS Chem Neurosci 6(1):48–67
doi: 10.1021/cn500256e
pubmed: 25546652
Krauss P, van Niftrik CHB, Muscas G, Scheffler P, Oertel MF, Stieglitz LH (2021) How to avoid pneumocephalus in deep brain stimulation surgery? Analysis of potential risk factors in a series of 100 consecutive patients. Acta Neurochir (Wien) 163(1):177–184
doi: 10.1007/s00701-020-04588-z
pubmed: 32960362
Kulisevsky J, Berthier ML, Gironell A, Pascual-Sedano B, Molet J, Parés P (2002) Mania following deep brain stimulation for Parkinson’s disease. Neurology 59(9):1421–1424. https://doi.org/10.1212/wnl.59.9.1421
doi: 10.1212/wnl.59.9.1421
pubmed: 12427895
Kumar R, Lozano AM, Kim YJ, Hutchison WD, Sime E, Halket E, Lang AE (1998) Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson’s disease. Neurology. https://doi.org/10.1212/WNL.51.3.850
Lee DJ, Lozano CS, Dallapiazza RF, Lozano AM (2019) Current and future directions of deep brain stimulation for neurological and psychiatric disorders. J Neurosurg 131(2):333–342
doi: 10.3171/2019.4.JNS181761
pubmed: 31370011
Lempka SF, Miocinovic S, Johnson MD, Vitek JL, McIntyre CC (2009) In vivo impedance spectroscopy of deep brain stimulation electrodes. J Neural Eng 6(4):046001
doi: 10.1088/1741-2560/6/4/046001
pubmed: 19494421
pmcid: 2861504
Limousin P, Foltynie T (2019) Long-term outcomes of deep brain stimulation in Parkinson disease. Nat Rev Neurol 15(4):234–242. https://doi.org/10.1038/S41582-019-0145-9
Limousin P, Pollak P, Benazzouz A, Hoffmann D, le Bas JF, Perret JE, Benabid AL, Broussolle E (1995) Effect of parkinsonian signs and symptoms of bilateral subthalamic nucleus stimulation. Lancet 345(8942):91–95
doi: 10.1016/S0140-6736(95)90062-4
pubmed: 7815888
Ludwig KA, Uram JD, Yang J, Martin DC, Kipke DR (2006) Chronic neural recordings using silicon microelectrode arrays electrochemically deposited with a poly(3,4-ethylenedioxythiophene) (PEDOT) film. J Neural Eng 3(1):59–70
doi: 10.1088/1741-2560/3/1/007
pubmed: 16510943
Lyons KE, Wilkinson SB, Overman J, Pahwa R (2004) Surgical and hardware complications of subthalamic stimulation: a series of 160 procedures. Neurology 63(4):612–616
doi: 10.1212/01.WNL.0000134650.91974.1A
pubmed: 15326230
Macia F, Perlemoine C, Coman I, Guehl D, Burbaud P, Cuny E, Gin H, Rigalleau V, Tison F (2004) Parkinson’s disease patients with bilateral subthalamic deep brain stimulation gain weight. Mov Disord 19(2):206–212. https://doi.org/10.1002/mds.10630
doi: 10.1002/mds.10630
pubmed: 14978678
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for Prevention of Surgical Site Infection, 1999. Am J Infect Control 27(2):97–134. https://doi.org/10.1016/S0196-6553(99)70088-X
McIntyre CC, Grill WM (2002) Extracellular stimulation of central neurons: influence of stimulus waveform and frequency on neuronal output. J Neurophysiol 88(4):1592–1604
doi: 10.1152/jn.2002.88.4.1592
pubmed: 12364490
Minafra B, Fasano A, Pozzi NG, Zangaglia R, Servello D, Pacchetti C (2014) Eight-years failure of subthalamic stimulation rescued by globus pallidus implant. Brain Stimul 7(2):179–181
doi: 10.1016/j.brs.2013.12.011
pubmed: 24629829
Morishita T, Okun MS, Burdick A, Jacobson CE IV, Foote KD (2013) Cerebral venous infarction: a potentially avoidable complication of deep brain stimulation surgery. Neuromodulation 16(5):407
doi: 10.1111/ner.12052
pubmed: 23738501
pmcid: 3772976
Moro E, Scerrati M, Romito LMA, Roselli R, Tonali P, Albanese A (1999) Chronic subthalamic nucleus stimulation reduces medication requirements in Parkinson’s disease. Neurology 53(1):85–90
doi: 10.1212/WNL.53.1.85
pubmed: 10408541
Nazzaro JM, Pahwa R, Lyons KE (2017) Symptomatic, non-infectious, non-hemorrhagic edema after subthalamic nucleus deep brain stimulation surgery for Parkinson’s disease. J Neurol Sci 383:42–46
doi: 10.1016/j.jns.2017.10.003
pubmed: 29246619
Oh MY, Abosch A, Kim SH, Lang AE, Lozano AM, Benabid AL, Sharan AD, Rezai AR, Starr P, Bakay RAE (2002) Long-term hardware-related complications of deep brain stimulation. Neurosurgery 50(6):1268–1276
pubmed: 12015845
Peña E, Pastor J, Hernando V, Gallego I, Pedrosa M, Carrasco R, Sola RG (2008) Skin erosion over implants in deep brain stimulation patients. Stereotact Funct Neurosurg 86(2):120–126. https://doi.org/10.1159/000116216
doi: 10.1159/000116216
pubmed: 18270483
Pouratian N, Reames DL, Frysinger R, Elias WJ (2011) Comprehensive analysis of risk factors for seizures after deep brain stimulation surgery. Clinical article. J Neurosurg 115(2):310–315. https://doi.org/10.3171/2011.4.JNS102075
doi: 10.3171/2011.4.JNS102075
pubmed: 21548744
Salatino JW, Ludwig KA, Kozai TDY, Purcell EK (2017) Glial responses to implanted electrodes in the brain. Nat Biomed Eng 1(11):862
doi: 10.1038/s41551-017-0154-1
pubmed: 30505625
pmcid: 6261524
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(5):998–1003
doi: 10.3171/JNS-07/11/0998
pubmed: 17977273
Sarica C, Iorio-Morin C, Aguirre-Padilla DH et al (2021) Implantable pulse generators for deep brain stimulation: challenges, complications, and strategies for practicality and longevity. Front Hum Neurosci 15:708481. https://doi.org/10.3389/FNHUM.2021.708481
doi: 10.3389/FNHUM.2021.708481
pubmed: 34512295
pmcid: 8427803
Seijo F, De Eulate A, Beramendi S, Santamarta Liébana E, Lozano Aragoneses B, Saiz Ayala A, Fernández De León R, Alvarez Vega MA (2014) 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 (Wien) 156(8):1505–1512
doi: 10.1007/s00701-014-2082-0
pubmed: 24752724
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(9):867–875
doi: 10.1007/s00701-007-1267-1
pubmed: 17690838
Servello D, Bona AR, Zekaj E (2016) Is capsulectomy a feasible and useful measure in internal pulse generator replacement procedures? A technical note on the use of the PEAK PlasmaBlade(TM). Acta Neurochir (Wien) 158(6):1165–1168
doi: 10.1007/s00701-016-2793-5
pubmed: 27084378
Servello D, Zekaj E, Saleh C, Pacchetti C, Porta M (2016) The pros and cons of intraoperative CT scan in evaluation of deep brain stimulation lead implantation: a retrospective study. Surg Neurol Int 7(Suppl 19):S551–S556
doi: 10.4103/2152-7806.187534
pubmed: 27583182
pmcid: 4982342
Sharma VD, Lyons KE, Nazzaro JM, Pahwa R (2020) Does post-operative symptomatic lead edema associated with subthalamic DBS implantation impact long-term clinical outcomes? J Neurol Sci 410:116647
doi: 10.1016/j.jns.2019.116647
pubmed: 31901593
Sobstyl M, Aleksandrowicz M, Ząbek M, Pasterski T (2019) Hemorrhagic complications seen on immediate intraprocedural stereotactic computed tomography imaging during deep brain stimulation implantation. J Neurol Sci 400:97–103
doi: 10.1016/j.jns.2019.01.033
pubmed: 30909114
Sofroniew M, v. (2014) Astrogliosis. Cold Spring Harb Perspect Biol. https://doi.org/10.1101/CSHPERSPECT.A020420
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(7):868–872
doi: 10.1136/jnnp.2005.081232
pubmed: 16574733
pmcid: 2117492
Wang X, Wang J, Zhao H et al (2017) Clinical analysis and treatment of symptomatic intracranial hemorrhage after deep brain stimulation surgery. Br J Neurosurg 31(2):217–222. https://doi.org/10.1080/02688697.2016.1244252
doi: 10.1080/02688697.2016.1244252
pubmed: 27760466
Xu S, Wang W, Chen S, Wu Q, Li C, Ma X, Chen T, Li W, Xu S (2021) Deep brain stimulation complications in patients with Parkinson’s disease and surgical modifications: a single-center retrospective analysis. Front Hum Neurosci. https://doi.org/10.3389/FNHUM.2021.684895/FULL
Yang C, Qiu Y, Wang J, Wu Y, Hu X, Wu X (2020) Intracranial hemorrhage risk factors of deep brain stimulation for Parkinson’s disease: a 2-year follow-up study. J Int Med Res. https://doi.org/10.1177/0300060519856747
Zekaj E, Saleh C, Ciuffi A, Franzini A, Servello D (2018) Venous infarct after sacrifice of single cortical vein during deep-brain stimulation surgery. Asian J Neurosurg 13(4):1276
doi: 10.4103/ajns.AJNS_126_18
pubmed: 30459916
pmcid: 6208239
Zeppa P, Fraccalvieri M, Fronda C, Lo Bue E, Rizzi L, Caliendo V, Lanotte MM (2022) Hardware-related skin erosion in deep brain stimulation for Parkinson’s disease: how far can we go? An illustrative case report. Brain Sci 12:1715. https://doi.org/10.3390/BRAINSCI12121715
doi: 10.3390/BRAINSCI12121715
pubmed: 36552174
pmcid: 9775376