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Hemorrhagic complications of microelectrode-guided deep brain stimulation
Devin K Binder1, Geoff Rau, Philip A Starr
1Department of Neurological Surgery, University of California, San Francisco, CA 94143-0112, USA. dbinder@itsa.ucsf.edu
Stereotactic and Functional Neurosurgery
|January 28, 2004
Summary
The risk of symptomatic hemorrhage during deep brain stimulator (DBS) implantation for movement disorders is 1.4% per lead. Brain target significantly impacts hemorrhage risk, with the globus pallidus having a higher incidence.
Area of Science:
- Neurosurgery
- Neurology
- Medical Devices
Background:
- Intracranial hemorrhage risk during deep brain stimulator (DBS) surgery for movement disorders is not well-defined.
- This study investigates hemorrhage incidence across multiple DBS targets.
Purpose of the Study:
- To determine the incidence of intracranial hemorrhage in patients undergoing microelectrode-guided DBS.
- To analyze hemorrhage risk based on specific brain targets: subthalamic nucleus (STN), thalamus (VIM), and internal globus pallidus (GPi).
Main Methods:
- Retrospective analysis of 357 DBS lead implants performed by a single surgeon (June 1998-April 2003).
- Postoperative imaging (CT or MRI) 4-24 hours after surgery.
- Hematomas >0.2 cm³ were classified as symptomatic or asymptomatic.
Main Results:
- A total of 11 hematomas (5 symptomatic, 6 asymptomatic) were identified, yielding a 3.1% overall hemorrhage risk per lead.
- Hemorrhage incidence varied by target: 2.5% for STN-DBS, 6.7% for GPi-DBS, and 0% for VIM-DBS.
- The overall symptomatic hemorrhage risk was 1.4% per lead implant.
Conclusions:
- Microelectrode-guided DBS carries a low risk of symptomatic hemorrhage (1.4% per lead).
- The specific brain target significantly influences the risk of hemorrhage during DBS implantation.
- GPi-DBS demonstrated a higher hemorrhage incidence compared to STN-DBS and VIM-DBS.