Surgical and hardware complications of deep brain stimulation. A seven-year experience and review of the literature

Boviatsis, Efstathios; Stavrinou, Lampis C.; Themistocleous, Marios; Kouyialis, Andreas T.; Sakas, Damianos E.

doi:10.1007/s00701-010-0749-8

Cited by 161 publications

(114 citation statements)

References 56 publications

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“…4,7,10,14,17,18,[20][21][22][23][24]27,28) Most are mild and transient, but some serious morbidity also occurs. The mortality rate during the first 30 postoperative days after stereotactic surgery was 0.4%, and the permanent surgical morbidity rate was 1%, mainly caused by ICH (2.2%) in a large series (1183 patients).…”

Section: Discussionmentioning

confidence: 99%

“…25) Device infection is one of the most probable device-related complications in DBS. 2,4,10,14,17,22,24) Since the DBS procedure involves the implantation of a foreign body, the risk of infection is high. Recent reported incidence of device infection varies from 0.4% to 10%.…”

Section: Discussionmentioning

confidence: 99%

“…8) DBS is considered to cause less morbidity than ablative procedures, but is associated with a significant incidence of adverse effects. 4,7,10,14,17,18,[20][21][22][23][24]27,28) In this study, we retrospectively analyzed DBSrelated complications in a consecutive series of 180 patients who underwent bilateral STN-DBS to consider preventive methods.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Complications of Subthalamic Nucleus Stimulation in Parkinson's Disease

Umemura

Oka

Yamamoto

et al. 2011

Neurol. Med. Chir.(Tokyo)

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Subthalamic nucleus deep brain stimulation (STN-DBS) is effective for medically refractory Parkinson's disease. We retrospectively analyzed complications in 180 consecutive patients who underwent bilateral STN-DBS. Surgery-related complications were symptomatic intracerebral hemorrhage in 2, chronic subdural hematoma in 1, and transient deterioration of medication-induced psychosis in 2 patients. Device-related complications involved device infection in 5, skin erosion in 5, and implantable pulse generator malfunction in 2 patients. All of these patients required surgical repair. Surgery and device-related complications could be reduced with increased surgical experience and the introduction of new surgical equipment and technology. Treatment or stimulation-related complications were intractable dyskinesia/dystonia in 11, problematic dysarthria in 7, apraxia of eyelid opening (ALO) in 11, back pain in 10, and restless leg syndrome in 6 patients. Neuropsychiatric complications were transient mood changes in some, impulse control disorder in 2, severe depression related to excessive reduction of dopaminergic medications in 2, rapid progression of dementia in 1, and suicide attempts in 2 patients. Most complications were mild and transient. Dysarthria and ALO were the most frequent permanent sequelae after STN-DBS. Treatment-related adverse events may be caused not only by the effect of stimulation effect but also excessive reduction of dopaminergic medication, or progression of the disease. In conclusion, STN-DBS seems to be a relatively safe procedure. Although serious complications with permanent sequelae are rare, significant incidences of adverse effects occur. Physicians engaged in this treatment should have a comprehensive understanding of the probable complications and how to avoid them.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Complications of Subthalamic Nucleus Stimulation in Parkinson's Disease

Umemura

Oka

Yamamoto

et al. 2011

Neurol. Med. Chir.(Tokyo)

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“…In one series of 100 DBS electrodes inserted in 55 patients for movement disorders, mostly for PD (50 patients), there were 2 electrode malpositions, 2 electrode fractures, 1 electrode migration, and 1 pulse-generator infection [76]. A similar frequency of electrode breakage and lead migration was observed in another study of 106 patients who underwent DBS surgery for various pathologies [77].…”

Section: Adverse Events and Failures Related To Dbsmentioning

confidence: 51%

Surgical Treatment of Parkinson's Disease: Patients, Targets, Devices, and Approaches

Shukla

Okun

2014

Neurotherapeutics

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Surgical treatment for Parkinson's disease (PD) has evolved from ablative procedures, within a variety of brain regions, to implantation of electrodes into specific targets of the basal ganglia. Electrode implantation surgery, referred to as deep brain stimulation (DBS), is preferred to ablative procedures by many experts owing to its reversibility, programmability, and the ability to be safely performed bilaterally. Several randomized clinical studies have demonstrated the effectiveness of DBS surgery for control of PD symptoms. Many brain targets, including the subthalamic nucleus and the globus pallidus internus, have emerged as potentially effective, with each target being closely associated with important pros and cons. Selection of appropriate PD candidates through a methodical interdisciplinary screening is considered a prerequisite for a successful surgical outcome. Despite recent growth in DBS knowledge, there is currently no consensus on the ideal surgical technique, the best surgical approach, and the most appropriate surgical target. DBS is now targeted towards treating specific PD-related symptoms in a given individual, and not simply addressing the disease with one pre-defined approach. In this review we will discuss the historical aspects of surgical treatments, the selection of an appropriate DBS candidate, the current surgical techniques, and recently introduced DBS-related technologies. We will address important pre-and postoperative issues related to DBS. We will also discuss the lessons learned from the randomized clinical studies for DBS and the shifting paradigm to tailor to a more patient-centered and symptom-specific approach.

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“…So in the literature, the effective supremacy of stimulation vs lesioning treatment is still discussed. [4][5][6] In their report, the authors 1 underline how a clinical problem of the patient, which had not been mitigated by previous DBS, was solved, not simply by changing the target of the lead from the thalamus to the zona incerta, but also by "casually" lesioning the surrounding tissue because of a strict adherence of it to the lead, as already rarely descripted in literature. 7 Thus, the authors 1 state that lesioning surgery is still a valid surgical alternative when stimulation fails.…”

mentioning

confidence: 99%

Letter: Thalamotomy-Like Effects From Partial Removal of a Ventral Intermediate Nucleus Deep Brain Stimulator Lead in a Patient With Essential Tremor: Case Report

et al. 2017

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Surgical and hardware complications of deep brain stimulation. A seven-year experience and review of the literature

Abstract: Complication rates after DBS surgery remain low, proving that DBS is not only effective but also safe. Certain strategies do exist in order to minimize complications.

Cited by 161 publications

References 56 publications

Complications of Subthalamic Nucleus Stimulation in Parkinson's Disease

Complications of Subthalamic Nucleus Stimulation in Parkinson's Disease

Surgical Treatment of Parkinson's Disease: Patients, Targets, Devices, and Approaches

Letter: Thalamotomy-Like Effects From Partial Removal of a Ventral Intermediate Nucleus Deep Brain Stimulator Lead in a Patient With Essential Tremor: Case Report

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