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Cerebral Intraparenchymal Hemorrhage due to Implantation of Electrodes for Deep Brain Stimulation: Insights from a
Bastian E A Sajonz1, Timo S Brugger1,2,3,4, Marco Reisert1,5
1Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany.
Insights
Cerebral intraparenchymal hemorrhage due to electrode implantation (CIPHEI) is a rare complication of deep brain stimulation (DBS). Older age, high invasivity, and directional DBS electrodes significantly increase CIPHEI risk when combined.
Area of Science:
- Neurosurgery
- Neurology
- Medical Devices
Background:
- Cerebral intraparenchymal hemorrhage due to electrode implantation (CIPHEI) is a serious complication of deep brain stimulation (DBS).
- Understanding risk factors is crucial for patient safety during DBS surgery.
Purpose of the Study:
- To determine the frequency of CIPHEI in a large single-center cohort.
- To identify patient- and procedure-related risk factors and their interactions for CIPHEI.
Main Methods:
- Retrospective analysis of DBS implantations from January 2013 to December 2021.
- Generalized linear model with bias reduction to analyze risk factors.
- Consideration of age, gender, hypertension, invasivity, electrode types, and DBS electrode implantation.
Main Results:
- 17 CIPHEI cases were identified across 839 electrode implantations (3.9% frequency).
- A three-way interaction of older age (>60 years), high invasivity (combined micro/macroelectrodes), and directional DBS electrodes accounted for 82.4% of CIPHEI cases.
- Acquired platelet dysfunction was found in only one case.
Conclusions:
- Older age, high invasivity, and directional DBS electrode implantation are significant risk factors for CIPHEI, particularly when combined.
- Directional DBS electrodes represent a newly identified potential risk factor.
- Risk is driven by the combined presence of these factors, not independently, highlighting the need for careful procedural risk evaluation in at-risk patients.
Abstract:
Cerebral intraparenchymal hemorrhage due to electrode implantation (CIPHEI) is a rare but serious complication of deep brain stimulation (DBS) surgery. This study retrospectively investigated a large single-center cohort of DBS implantations to calculate the frequency of CIPHEI and identify patient- and procedure-related risk factors for CIPHEI and their potential interactions. We analyzed all DBS implantations between January 2013 and December 2021 in a generalized linear model for binomial responses using bias reduction to account for sparse sampling of CIPHEIs. As potential risk factors, we considered age, gender, history of arterial hypertension, level of invasivity, types of micro/macroelectrodes, and implanted DBS electrodes. If available, postoperative coagulation and platelet function were exploratorily assessed in CIPHEI patients. We identified 17 CIPHEI cases across 839 electrode implantations in 435 included procedures in 418 patients (3.9%). Exploration and cross-validation analyses revealed that the three-way interaction of older age (above 60 years), high invasivity (i.e., use of combined micro/macroelectrodes), and implantation of directional DBS electrodes accounted for 82.4% of the CIPHEI cases. Acquired platelet dysfunction was present only in one CIPHEI case. The findings at our center suggested implantation of directional DBS electrodes as a new potential risk factor, while known risks of older age and high invasivity were confirmed. However, CIPHEI risk is not driven by the three factors alone but by their combined presence. The contributions of the three factors to CIPHEI are hence not independent, suggesting that potentially modifiable procedural risks should be carefully evaluated when planning DBS surgery in patients at risk.
