Hemorrhagic complications of microelectrode-guided deep brain stimulation.
BACKGROUND
The incidence of intracranial hemorrhage occurring during microelectrode-guided implantation of deep brain stimulators (DBS) for movement disorders has not been well defined. We report the incidence of hemorrhage in a large series of DBS implants into the subthalamic nucleus (STN), thalamus (VIM) and internal globus pallidus (GPi).


METHODS
All DBS procedures performed by a single surgeon (P.A.S.) between June 1998 and April 2003 were included in this study. Patients had postoperative imaging (MRI or CT) 4-24 h following surgery, and all hematomas >0.2 cm(3) in volume were noted and scored as symptomatic (associated with any new neurologic deficit lasting >24 h) or asymptomatic.


RESULTS
The total number of lead implants was 357. There were 5 symptomatic hematomas and 6 asymptomatic hematomas. The relative risk of hematoma (any type) per lead implant was 3.1%. The incidence of hematoma by target site was 2.5% per lead for STN-DBS, 6.7% for GPi-DBS and 0% for VIM-DBS.


CONCLUSIONS
The overall risk of intraoperative or early postoperative symptomatic hemorrhage with microelectrode-guided DBS, over all targets, was 1.4% per lead implant. The brain target had a significant effect on the risk of hemorrhage.
Binder
Devin K
DK
Department of Neurological Surgery, University of California, San Francisco, CA 94143-0112, USA. dbinder@itsa.ucsf.edu
Rau
Geoff
G
Starr
Philip A
PA
D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D004599:Electric Stimulation Therapy / Q000009:adverse effects*; D005917:Globus Pallidus / Q000601:surgery; D006801:Humans; D015994:Incidence; D008839:Microelectrodes / Q000009:adverse effects*; D009069:Movement Disorders / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D020531:Subthalamic Nucleus / Q000601:surgery; D013788:Thalamus / Q000601:surgery