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[Comparison and examination of stereotactic surgical complications in movement disorders]
Tohru Terao1, Ryouichi Okiyama, Hiroshi Takahashi
1Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu-city, Tokyo 183-0042, Japan.
Abstract:
The purpose of the present study was to determine exactly the incidence of surgical complications in patients for whom MRI-targeted, microelectrode recording (MER)-guided implantation of deep brain stimulation (DBS) or radiofrequency (RF)-coagulation surgery was performed. Between January, 1998 and September, 2002, a total of 110 stereotactic surgeries for movement disorders (57 RF-coagulations and 53 implantations of DBS) were performed. We investigated the type and number of complications for each of the following surgical targets; globus pallidus, thalamus, and subthalamic nucleus (STN). Twenty-four neurological complications in 22 patients and 16 radiological/instrumental complications in 16 patients were verified among the 110 surgeries. Among the neurological complications, hemiparesis and mental disturbances were observed at a high rate, while intraoperative hemorrhage frequently occurred among the radiological/instrumental complications. The rate of neurological and radiological/instrumental complications for each of the stereotactic targets; the globus pallidus, thalamus, and STN-targeted surgeries, was 32.4%, 16.7%, 18.8% and 16.2%, 20.0%, 12.5%, respectively. The reason for the high rate of intraoperative hemorrhage may be associated with technical problems resulting from the penetration of vessels by needles, as well as the destruction of small vessels due to heat ablation. As for the mental disturbances, visual hallucinations (VH) occurred a high rate, especially during STN-DBS. Peduncular damage and/or L-dopa toxicity due to STN-DBS may have been associated with VH, so the STN-DBS may therefore be thought to change the threshold of stimulus-induced hallucinations. We also found that the procedures for DBS surgery, especially in younger patients, have a lower risk of complication, while, on the other hand, coagulation surgery for elderly patients is accompanied by of high risks, from the standpoint of surgical complications.
Insights
This study analyzed surgical complications from deep brain stimulation (DBS) and radiofrequency (RF) coagulation for movement disorders. Younger patients undergoing DBS had fewer complications, while elderly patients undergoing RF coagulation faced higher risks.
Area of Science:
- Neurosurgery
- Neurology
- Medical Engineering
Background:
- Stereotactic surgery, including deep brain stimulation (DBS) and radiofrequency (RF) coagulation, is used for movement disorders.
- Assessing surgical complication rates is crucial for patient safety and procedural refinement.
Purpose of the Study:
- To determine the incidence of surgical complications in MRI-targeted, microelectrode recording (MER)-guided DBS and RF-coagulation procedures.
- To analyze complication types and rates across different surgical targets (globus pallidus, thalamus, subthalamic nucleus).
Main Methods:
- Retrospective analysis of 110 stereotactic surgeries (57 RF-coagulations, 53 DBS implantations) performed between January 1998 and September 2002.
- Categorization of complications into neurological and radiological/instrumental.
- Evaluation of complication rates based on surgical target and patient demographics.
Main Results:
- A total of 24 neurological and 16 radiological/instrumental complications were observed.
- Hemiparesis and mental disturbances were common neurological complications; intraoperative hemorrhage was frequent radiologically.
- Subthalamic nucleus (STN)-targeted DBS showed a higher rate of visual hallucinations (VH).
Conclusions:
- Deep brain stimulation (DBS) surgery, particularly in younger patients, presents a lower risk of complications.
- Radiofrequency (RF) coagulation surgery in elderly patients is associated with higher complication risks.
- STN-DBS may alter the threshold for stimulus-induced hallucinations, potentially linked to peduncular damage or L-dopa toxicity.