Long-term hardware-related complications of deep brain stimulation.
OBJECTIVE
To determine the incidence of long-term hardware-related complications of deep brain stimulation (DBS).


METHODS
The study design is a retrospective chart review of a single-surgeon, single-institution experience with DBS in 84 consecutive cases from 1993 to 1999. Only patients with a minimum follow-up of 1 year were considered. Five patients were excluded because trial stimulation failed to achieve pain relief (n = 4) or because the procedure was aborted owing to hemorrhage (n = 1). Seventy-nine patients received 124 permanent DBS electrode implants.


RESULTS
The mean follow-up period was 33 months, and the cumulative follow-up time was 217 patient-years or 310 electrode-years. Overall, 20 patients (25.3%) had 26 hardware-related complications involving 23 (18.5%) of the electrodes. There were 4 lead fractures, 4 lead migrations, 3 short or open circuits, 12 erosions and/or infections, 2 foreign body reactions, and one cerebrospinal fluid leak. The hardware-related complication rate per electrode-year was 8.4%. The most common complications were related to the electrode connectors. A significant finding was a high number of complications involving erosions or infections, which occurred in 7 of 12 instances as a late complication (beyond 12 mo).


CONCLUSIONS
Long-term follow-up reveals that hardware-related complications occur in a significant number of patients. Factors that lead to such complications must be identified and addressed to maximize the important benefits of DBS therapy.
Oh
Michael Y
MY
Division of Neurosurgery, The Toronto Hospital, Western Division, University of Toronto, Toronto, Ontario, Canada.
Abosch
Aviva
A
Kim
Seong H
SH
Lang
Anthony E
AE
Lozano
Andres M
AM
D000328:Adult; D000368:Aged; D001921:Brain / Q000503:physiopathology*; D002543:Cerebral Hemorrhage / Q000209:etiology; D020878:Device Removal; D004599:Electric Stimulation Therapy / Q000009:adverse effects*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000601:surgery; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000628:therapy; D059408:Pain Management; D010166:Palliative Care / Q000379:methods; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000601:surgery; D013997:Time Factors