Perioperative Technical Complications in Deep Brain Stimulation Surgeries

Deep brain stimulation (DBS) surgeries are multi-faceted and the various steps are interconnected. Since its first implementation, the method of DBS surgery has undergone changes. We have encountered several expected and also non-expected perioperative technical complications in the past seventeen years. Here, we describe the stereotactic frame, stereotactic localizer and planning station related complications and how we have managed them as much as possible.

This study is a retrospective qualitative analysis of the documented technical events encountered during DBS surgeries from 1999 onwards. We have collected these events from a cohort of approximately 921 DBS electrodes implantations from the centers of the authors.

Stereotactic frame related complications included movement related fixation problems, head anatomy related problems, and lack of maintenance related issues. Localizer related complications were compatibility issues of the stereotactic localizer and planning station, field of view effect on fiducials, air bubbles in localizers using liquid solutions, and disengaged localizer effect. Planning station related complications included image fusion failures and cerebrospinal fluid signal effect on image fusion.

The road to success in DBS therapy passes through the ability to cope with surgical and technical complications. Each step is unconditionally connected to the other, and detection of the problems that can be encountered in advance and preparations for these negative conditions are the key to success for the group responsible for executing the therapy. We are still learning from these events and advance our surgical approaches.