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Published on: October 15, 2021
Intracranial hemorrhage after removal of deep brain stimulation electrodes
James K C Liu1, Hesham Soliman, Andre Machado
1Center for Neurological Restoration, Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Insights
Removing deep brain stimulation (DBS) electrodes carries a 12.8% risk of intracranial hemorrhage, which is significantly higher than the risk during implantation. Fortunately, these hemorrhages are typically asymptomatic.
Area of Science:
- Neurosurgery
- Neurology
- Medical Imaging
Background:
- Deep brain stimulation (DBS) electrode placement is associated with hemorrhage risk.
- Limited data exists on intracranial hemorrhage incidence following DBS electrode removal.
Purpose of the Study:
- To determine the incidence and trends of intracranial hemorrhage after DBS electrode removal.
- To compare hemorrhage risk during DBS lead removal versus implantation.
Main Methods:
- Retrospective chart review of 78 DBS electrode removals at Cleveland Clinic (2000-2010).
- Analysis of patient data including age, sex, lead characteristics, and comorbidities.
- Postoperative CT scans evaluated for hemorrhages.
Main Results:
- 12.8% (10 of 78) of DBS lead removals resulted in intracranial hemorrhages.
- Hemorrhages were superficial cortical (60%) or deep (40%).
- Hemorrhage risk during removal (12.8%) significantly exceeded that during implantation (2.0%).
Conclusions:
- DBS lead removal poses a significantly higher risk of postoperative intracranial hemorrhage compared to implantation.
- Detected hemorrhages were asymptomatic and visualized on imaging.
Object:
Many previous studies have shown that placement of deep brain stimulation (DBS) electrodes carries a considerable risk of hemorrhage. To date, no studies have evaluated the incidence of intracranial hemorrhage after removal of DBS electrodes. The authors performed a retrospective chart review to identify the incidence and trends in hemorrhage after DBS electrode removal.
Methods:
A retrospective chart review of all DBS electrodes removed at the Cleveland Clinic between October 2000 and May 2010 was performed. All patients underwent postoperative CT scanning. Each patient was evaluated for age, sex, side of placement, target, duration of lead placement, reason for removal, and medical comorbidities.
Results:
A total of 78 lead removals were performed in the 10-year period (1300 leads were implanted during the same period). Of the 78 leads removed, 10 (12.8%) resulted in hemorrhages seen on postoperative CT scans. The hemorrhages were superficial cortical in 6 cases of lead removal (60%) and deep in 4 cases (40%). No statistically significant correlation to any of the factors evaluated was found. All hemorrhages were asymptomatic. The authors' retrospective study of 78 DBS lead removals revealed a high risk of intracranial hemorrhage (12.8% per lead). The risk of hemorrhage during removal is significantly greater than the risk of hemorrhage during implantation (2.0% per lead at the authors' center during the same period). There were more superficial hemorrhages, and all hemorrhages were asymptomatic.
Conclusions:
Removal of DBS leads carries a significantly higher risk of postoperative hemorrhages that are seen on images but are not clinically symptomatic.
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