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Clinical analysis and treatment of symptomatic intracranial hemorrhage after deep brain stimulation surgery
Xin Wang1, Jing Wang1, Haikang Zhao2
1a Department of Neurosurgery , Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
Insights
Symptomatic intracranial hemorrhage (ICH) after deep brain stimulation (DBS) surgery is a rare but serious complication. Early identification and effective treatment are crucial for preserving DBS leads and limiting neurological deficits.
Area of Science:
- Neurosurgery
- Neurology
Background:
- Symptomatic intracranial hemorrhage (ICH) is a significant risk associated with deep brain stimulation (DBS) surgery, potentially causing permanent neurological disability.
- The clinical application of DBS is hindered by the risk of ICH, necessitating research into its incidence, prevention, and management.
Purpose of the Study:
- To investigate the incidence, clinical characteristics, and outcomes of symptomatic intracranial hemorrhage (ICH) following deep brain stimulation (DBS) surgery.
- To inform strategies for the prevention and effective treatment of ICH in DBS patients.
Main Methods:
- Retrospective analysis of 396 patients undergoing DBS with 691 leads from January 2009 to December 2014.
- Detailed examination of 10 patients who experienced symptomatic ICH, including clinical data, imaging, and treatment outcomes.
Main Results:
- Ten patients (2.5% of total) developed symptomatic ICH, with 7 cases occurring around implanted electrodes.
- Hemorrhage typically occurred within 24 hours post-surgery, often in the frontal lobe, with some cases presenting with seizures.
- Conservative management was effective for most patients; all electrodes were preserved, and neurological function improved, leading to successful Parkinson's disease symptom relief in nine patients.
Conclusions:
- Prompt identification and management of symptomatic ICH are vital after DBS implantation.
- Effective treatment strategies can limit neurological deficits and ensure the preservation of DBS leads for continued therapeutic benefit.
Background:
Symptomatic intracranial hemorrhage (ICH) may lead to permanent neurological disability of patients and has impeded the extensive clinical application of deep brain stimulation (DBS). The present study was conducted to discuss the incidence, prevention, and treatment of symptomatic ICH after DBS surgery.
Methods:
From January 2009 to December 2014, 396 patients underwent DBS with a total of 691 implanted leads. In all, 10 patients had symptomatic ICH. We analyzed these cases' clinical characteristics, including comorbid diagnoses and coagulation profile. We described the onset of ICH, imaging features, clinical manifestations, treatment, neurological impairment, and outcome of DBS.
Results:
Of the 10 patients with symptomatic ICH, 2 had hypertension. Three cases of ICH occurred within 12 h of the procedure; four cases within 24 h. Five experienced grand mal seizures concurrently with hemorrhage. Unilateral frontal lobe hemorrhage occurred in all cases. In seven cases, hematomas occurred around the electrodes. Some hematomas were not well-circumscribed and had perihematomal edema. Conservative therapy was administered to 8 patients, and 2 patients underwent craniotomy and hematoma evacuation. All electrodes were successfully preserved. Neurological dysfunction in all patients gradually improved. Nine patients ultimately experienced effective symptom relief of Parkinson's disease with DBS.
Conclusions:
Symptomatic ICH should be identified as soon as possible after implantation surgery and treated effectively to limit neurological deficit and preserve DBS leads.
