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Analysis of hemorrhagic risk factors during deep brain stimulation surgery for movement disorders: comparison of the
Jin Hoon Park1, Sun Ju Chung, Chong Sik Lee
1Center for Parkinson and Alzheimer's Disease, Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea.
Insights
The circumferential paired microelectrode insertion (CPMI) method significantly reduced bleeding risk in deep brain stimulation (DBS) surgery compared to multiple microelectrode insertion (MMI). This safer surgical option shows promise for DBS procedures.
Area of Science:
- Neurosurgery
- Neurology
- Surgical Techniques
Background:
- Intracranial hemorrhage is a critical complication of deep brain stimulation (DBS).
- Identifying risk factors and optimizing surgical techniques are crucial for patient safety in DBS.
- This study investigates hemorrhage risk associated with different microelectrode insertion methods.
Purpose of the Study:
- To assess risk factors for intracranial hemorrhage during DBS surgery.
- To compare the hemorrhagic risk between multiple microelectrode insertion (MMI) and circumferential paired microelectrode insertion (CPMI) techniques.
Main Methods:
- A retrospective analysis of 171 DBS procedures performed by a single neurosurgeon.
- Patients included those with Parkinson's disease, essential tremor, and dystonia.
- Comparison of bleeding rates between MMI and CPMI techniques, analyzing factors like gender, age, and hypertension.
Main Results:
- Nine postoperative hemorrhagic events occurred (5.26%), with three symptomatic (1.75%) and one permanent neurological deficit (0.58%).
- The CPMI method showed no instances of bleeding (0/65), significantly lower than the MMI method (9/106, 8.5%; p=0.04).
- No significant correlation was found between hemorrhage and other analyzed factors (gender, age, hypertension, target location, bilateral procedures).
Conclusions:
- The circumferential paired microelectrode insertion (CPMI) technique significantly reduces the rate of bleeding in DBS surgery.
- CPMI appears to be a safe and accurate surgical option for deep brain stimulation.
- This technique may be recommended as an alternative surgical approach for DBS procedures.
Background:
The most serious complication of deep brain stimulation (DBS) surgery is intracranial hemorrhage. The authors have assessed risk factors for hemorrhage in DBS surgery and compared two types of microelectrode insertion technique on hemorrhagic risk.
Methods:
A total of 171 DBS procedures were performed on 110 patients (58 females, 52 males) by the same neurosurgeon at a single center between May 2005 and May 2010. We used two microelectrode insertion methods: multiple microelectrode insertion (MMI) and circumferential paired microelectrode insertion (CPMI). We analyzed the correlation between bleeding rates and gender, age, hypertension, target location, simultaneous bilateral procedure and electrode insertion method.
Results:
Of the 171 DBS procedures, 138 were on 85 patients with Parkinson's disease, 16 were in 15 patients with essential tremor and 17 were on ten patients with dystonia. There were nine postoperative hemorrhagic events (5.26%), of which three were symptomatic (1.75%), and one permanent neurological deficit event (0.58%). Compared with the bleeding rate in the MMI method (9/106, 8.5%), there was no instance of bleeding with the CPMI method (0/65, 0%) (p = 0.04). In other factors, the correlation with hemorrhage was not found.
Conclusion:
Use of the CPMI method significantly decreased the rate of bleeding. This new surgical technique seems to be safe and accurate and may be recommended as another surgical option.
