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      Experience Reduces Surgical and Hardware-Related Complications of Deep Brain Stimulation Surgery: A Single-Center Study of 181 Patients Operated in Six Years

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          Abstract

          Objective

          Deep brain stimulation (DBS) surgery has increasingly been performed for the treatment of movement disorders and is associated with a wide array of complications. We aimed to present our experience and discuss strategies to minimize adverse events in light of this contemporary series and others in the literature.

          Methods

          A retrospective chart review was conducted to collect data on age, sex, indication, operation date, surgical technique, and perioperative and late complications.

          Results

          A total of 181 patients (113 males, 68 females) underwent DBS implantation surgery (359 leads) in the past six years. Indications and targets were as follows: Parkinson's disease (STN) ( n=159), dystonia (GPi) ( n=13), and essential tremor (Vim) ( n=9). Mean age was 55.2 ± 11.7 (range 9–74) years. Mean follow-up duration was 3.4 ± 1.6 years. No mortality or permanent morbidity was observed. Major perioperative complications were confusion (6.6%), intracerebral hemorrhage (2.2%), stroke (1.1%), and seizures (1.1%). Long-term adverse events included wound (7.2%), mostly infection, and hardware-related (5.5%) complications. Among several factors, only surgical experience was found to be related with overall complication rates (early period: 31% versus late period: 10%; p=0.001).

          Conclusion

          The rates of both early and late complications of DBS surgery are acceptably low and decrease significantly with cumulative experience.

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          Most cited references34

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          Risks of common complications in deep brain stimulation surgery: management and avoidance.

          K. Simpson, Francisco Fenoy (2013)
          Deep brain stimulation (DBS) surgery is increasingly prominent in the treatment of various disorders refractory to medication. Despite the procedure's efficacy, the community at large continues to be hesitant about presumed associated risks. The main object of this study was to assess the incidence of various surgical complications occurring both during and after DBS device implantation in a large population of patients with movement disorders in an effort to better quantify patient risk, define management plans, and develop methods for risk avoidance. A second aim was to corroborate the low procedural complication risk of DBS reported by others, which in light of the procedure's efficacy is needed to promote its widespread acceptance. All patients who had undergone new DBS device implantation surgery between 2002 and 2010 by a single surgeon were entered into a database after being verified by cross-referencing manufacturer implantation records. All surgical records and charts were reviewed to identify intraoperative, perioperative, and long-term surgical complications, including any characteristics predictive of an adverse event. Seven hundred twenty-eight patients received 1333 new DBS electrodes and 1218 new internal pulse generators (IPGs) in a total of 1356 stereotactic procedures for the treatment of movement disorders. Seventy-eight percent of the patients had staged lead and IPG implantations. Of the 728 patients, 452 suffered from medically refractory Parkinson disease; in the other patients, essential tremor (144), dystonia (64), mixed disease (30), and other hyperkinetic movement disorders (38) were diagnosed. Severe intraoperative adverse events included vasovagal response in 6 patients (0.8%), hypotension in 2 (0.3%), and seizure in 2 (0.3%). Postoperative imaging confirmed asymptomatic intracerebral hemorrhage (ICH) in 4 patients (0.5%), asymptomatic intraventricular hemorrhage in 25 (3.4%), symptomatic ICH in 8 (1.1%), and ischemic infarction in 3 (0.4%), associated with hemiparesis and/or decreased consciousness in 13 (1.7%). Long-term complications of DBS device implantation not requiring additional surgery included hardware discomfort in 8 patients (1.1%) and loss of desired effect in 10 (1.4%). Hardware-related complications requiring surgical revision included wound infections in 13 patients (1.7%), lead malposition and/or migration in 13 (1.7%), component fracture in 10 (1.4%), component malfunction in 4 (0.5%), and loss of effect in 19 (2.6%). The authors confirmed that the overall risk of both procedure- and hardware-related adverse events is acceptably low. They offer advice on how to avoid the most common complications.
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            Long-term hardware-related complications of deep brain stimulation.

            A Lozano, Catherine E. Lang, Aviva Abosch … (2002)
            To determine the incidence of long-term hardware-related complications of deep brain stimulation (DBS). The study design is a retrospective chart review of a single-surgeon, single-institution experience with DBS in 84 consecutive cases from 1993 to 1999. Only patients with a minimum follow-up of 1 year were considered. Five patients were excluded because trial stimulation failed to achieve pain relief (n = 4) or because the procedure was aborted owing to hemorrhage (n = 1). Seventy-nine patients received 124 permanent DBS electrode implants. The mean follow-up period was 33 months, and the cumulative follow-up time was 217 patient-years or 310 electrode-years. Overall, 20 patients (25.3%) had 26 hardware-related complications involving 23 (18.5%) of the electrodes. There were 4 lead fractures, 4 lead migrations, 3 short or open circuits, 12 erosions and/or infections, 2 foreign body reactions, and one cerebrospinal fluid leak. The hardware-related complication rate per electrode-year was 8.4%. The most common complications were related to the electrode connectors. A significant finding was a high number of complications involving erosions or infections, which occurred in 7 of 12 instances as a late complication (beyond 12 mo). Long-term follow-up reveals that hardware-related complications occur in a significant number of patients. Factors that lead to such complications must be identified and addressed to maximize the important benefits of DBS therapy.
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              Surgical and hardware complications of subthalamic stimulation: a series of 160 procedures.

              Scott Lyons, Michael Overman, Mark I. Wilkinson … (2004)
              To assess the surgical and hardware complications in a series of 81 consecutive patients undergoing subthalamic (STN) deep brain stimulation (DBS) for Parkinson disease (PD). The authors prospectively documented surgical and hardware complications occurring at the time of surgery and at subsequent neurologic and surgical evaluations for an average of 17 months, ranging from 1 to 54 months. No patient had a serious surgical complication resulting in death or permanent neurologic deficit. One patient had an intracranial hemorrhage but with no permanent deficit. In follow-up, 2.5% had infections requiring system removal, 3.7% had infections requiring implantable pulse generator (IPG) removal, 12.5% had misplaced leads, and 26.2% had hardware complications including lead migration, lead fracture, extension erosion, extension fracture, and IPG malfunction. Serious complications leading to permanent neurologic deficit are rare after STN DBS for advanced PD. However, long-term follow-up demonstrated that hardware complications are relatively common, having occurred in approximately 26% of these patients.
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                Author and article information

                Contributors
                Hayri Kertmen:
                ORCID: http://orcid.org/0000-0002-7113-9830
                Journal
                Journal ID (nlm-ta): Parkinsons Dis
                Journal ID (iso-abbrev): Parkinsons Dis
                Journal ID (publisher-id): PD
                Title: Parkinson's Disease
                Publisher: Hindawi
                ISSN (Print): 2090-8083
                ISSN (Electronic): 2042-0080
                Publication date Collection: 2018
                Publication date (Electronic): 22 July 2018
                Volume: 2018
                Electronic Location Identifier: 3056018
                Affiliations
                1Department of Neurosurgery, Diskapi Yildirim Beyazit Training and Research Hospital, Health Sciences University, Ankara, Turkey
                2Department of Neurology, Diskapi Yildirim Beyazit Training and Research Hospital, Health Sciences University, Ankara, Turkey
                Author notes

                Academic Editor: Carlo Colosimo

                Author information
                http://orcid.org/0000-0001-5436-8618
                http://orcid.org/0000-0002-7113-9830
                Article
                DOI: 10.1155/2018/3056018
                PMC ID: 6081564
                SO-VID: 0b3fc99c-c4c1-410c-803b-26451baf4149
                Copyright © Copyright © 2018 Mehmet Sorar et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 29 January 2018
                Date accepted : 23 May 2018
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Neurology
                Data availability:
                ScienceOpen disciplines: Neurology

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