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Risks of common complications in deep brain stimulation surgery: management and avoidance
Albert J Fenoy1, Richard K Simpson
1Mischer Neuroscience Institute, Department of Neurosurgery, The University of Texas Health Science Center at Houston; and.
Journal of Neurosurgery
|November 19, 2013
Summary
Deep brain stimulation (DBS) surgery for movement disorders has a low incidence of surgical complications. This study quantifies risks, aiding management and promoting acceptance of this effective treatment.
Area of Science:
- Neurosurgery
- Neurology
- Medical Device Technology
Background:
- Deep brain stimulation (DBS) is a prominent treatment for medication-refractory movement disorders.
- Public apprehension regarding DBS surgery risks persists despite its efficacy.
- Quantifying surgical complication rates is crucial for patient risk assessment and treatment acceptance.
Purpose of the Study:
- To assess the incidence of surgical complications during and after DBS device implantation in patients with movement disorders.
- To quantify patient risk, define management strategies, and develop risk avoidance methods for DBS procedures.
- To corroborate the low procedural complication risk of DBS to promote its wider adoption.
Main Methods:
- A retrospective review of surgical records and charts for 728 patients who underwent DBS implantation between 2002 and 2010 by a single surgeon.
- Identification and categorization of intraoperative, perioperative, and long-term surgical complications.
- Analysis of potential characteristics predictive of adverse events associated with DBS device implantation.
Main Results:
- A total of 1356 stereotactic procedures were performed, with 728 patients receiving new DBS electrodes and internal pulse generators (IPGs).
- Low rates of severe intraoperative events (e.g., vasovagal response 0.8%, seizure 0.3%) and asymptomatic/symptomatic hemorrhages (e.g., asymptomatic ICH 0.5%, symptomatic ICH 1.1%) were observed.
- Long-term complications included hardware discomfort (1.1%), loss of effect (1.4%), wound infections (1.7%), lead issues (1.7%), and component failures (0.5-1.4%).
Conclusions:
- The overall risk of procedure- and hardware-related adverse events associated with DBS implantation is acceptably low.
- The study provides insights into managing and avoiding common complications in DBS surgery.
- Findings support the safety profile of DBS, encouraging its broader application for movement disorders.
