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Hemorrhagic complication of stereotactic surgery in patients with movement disorders
Tohru Terao1, Hiroshi Takahashi, Fusako Yokochi
1Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan. tohru@jg7.so-net.ne.jp
Object:
Small, asymptomatic hemorrhages are easier to detect during stereotactic surgery when magnetic resonance (MR) imaging is used for targeting rather than when traditional approaches, such as ventriculography, are performed with contrast material. In the present study the authors examined the actual incidence of intraoperative hemorrhages in patients with movement disorders who had undergone MR imaging-targeted surgery, microelectrode recording (MER)-guided implantation of deep brain stimulation (DBS) electrodes, or radiofrequency-induced coagulation surgery performed.
Methods:
Ninety-six consecutive patients underwent a total of 116 stereotactic operations for movement disorders (57 operations for radiofrequency-induced coagulation and 59 for DBS electrode implantation) between January 1998 and November 2002. The authors investigated the correlation between hemorrhages and other factors including the location of the hemorrhage and the type of surgery performed. Postoperative computerized tomography scans demonstrated the occurrence of intraoperative hemorrhages at 12 locations during 11 procedures (9.5% of all procedures). Nine hemorrhages occurred during 57 coagulation operations (15.8%). Within this group, the frequency of hemorrhages was highest during thalamotomy (five [21.7%] of 23 procedures) and lower during pallidotomy (four [11.8%] of 34 procedures). In contrast, only two intraventricular hemorrhages developed during 59 operations in which DBS electrodes were implanted (3.4%). In no case was hemorrhage detected in the main DBS target, that is, the subthalamic nucleus.
Conclusions:
When small, asymptomatic hemorrhages were included in the estimation, the actual rate of hemorrhage was higher than that previously reported. Judging from the incidence of hemorrhage during coagulation and DBS surgeries, the authors suggest that the heat induced by coagulation may play a larger role than microelectrode penetration in the development of hemorrhage.
Insights
Radiofrequency coagulation surgery for movement disorders has a higher hemorrhage rate than deep brain stimulation (DBS) electrode implantation. Heat from coagulation may increase hemorrhage risk more than microelectrode use.
Area of Science:
- Neurosurgery
- Neurology
- Medical Imaging
Background:
- Stereotactic surgery for movement disorders utilizes various targeting and surgical techniques.
- Magnetic resonance (MR) imaging aids in detecting small, asymptomatic hemorrhages during surgery.
- Traditional methods like ventriculography may have limitations in hemorrhage detection.
Purpose of the Study:
- To examine the incidence of intraoperative hemorrhages in patients undergoing stereotactic surgery for movement disorders.
- To compare hemorrhage rates between MR imaging-targeted deep brain stimulation (DBS) electrode implantation and radiofrequency-induced coagulation surgery.
- To investigate factors influencing hemorrhage occurrence, including surgical technique and hemorrhage location.
Main Methods:
- Retrospective analysis of 116 stereotactic operations (57 coagulation, 59 DBS) performed between 1998 and 2002.
- Patients had movement disorders and underwent MR imaging-targeted procedures.
- Postoperative CT scans were used to identify and locate intraoperative hemorrhages.
Main Results:
- An overall intraoperative hemorrhage rate of 9.5% (11 of 116 procedures) was observed.
- Radiofrequency coagulation surgery showed a higher hemorrhage incidence (15.8%) compared to DBS electrode implantation (3.4%).
- Hemorrhage frequency was highest during thalamotomy (21.7%) within the coagulation group; no hemorrhages occurred in the subthalamic nucleus target for DBS.
Conclusions:
- The actual rate of hemorrhage in stereotactic surgery is higher when including small, asymptomatic bleeds.
- Heat generated during radiofrequency coagulation appears to be a more significant factor in hemorrhage development than microelectrode penetration.
- DBS surgery demonstrates a lower risk profile for intraoperative hemorrhages compared to radiofrequency coagulation.