Analysis of Delayed Intracerebral Hemorrhage Associated with Deep Brain Stimulation Surgery

Deep brain stimulation (DBS) may cause various complications including intracerebral hemorrhage (ICH). Because ICH causes devastating neurologic outcomes, various surgical techniques are attempting to reduce the chances of ICH. More importantly, early detection and proper management of postoperative ICH are indispensable. ICH may occur immediately or delayed following DBS; in this study, we analyzed the clinical features of delayed ICH after DBS.

Patients (n = 272) underwent postoperative brain computed tomography (CT) immediately after and 1 day after DBS between January 2008 and November 2016. Among these patients, 136 patients had Parkinson disease, 54 suffered from dystonia, 47 presented with essential tremor, and 9 had obsessive-compulsive disorder.

Out of the 272 patients who underwent 448 DBS lead implantations, 13 patients showed postoperative ICH. The ICH rate was 2.9% per lead and 4.77% per patient during the study period. Three patients (1.1%) demonstrated ICH immediately after DBS, and 10 patients (3.7%) demonstrated delayed ICH. Among them, only 1 patient showed large ICH (30 cm³) with elevation of intracranial pressure, subsequently undergoing ICH removal surgery and recovering without permanent neurologic deficits. The other 12 patients demonstrated small ICH (1-10 cm³). None of the patients with ICH demonstrated permanent disability.

Our study demonstrates that delayed ICH can occur after DBS even with normal brain CT immediately after DBS. Because ICH can cause serious neurological sequelae, the possibility of delayed ICH after DBS should be considered for the optimal management of patients.