Magnetic resonance-based deep brain stimulation technique: a series of 478 consecutive implanted electrodes with no perioperative intracerebral hemorrhage.
OBJECTIVE
The aim of this study was to determine the safety of a deep brain stimulation technique consisting of a combination of routine general anesthesia, magnetic resonance imaging direct targeting, and a single penetration technique in a large population of patients undergoing operation for movement disorders.


METHODS
One hundred ninety-four patients treated with deep brain stimulation between 1996 and 2007 were assessed via a computerized database for intra- and perioperative events. Most patients were young; only 62 of them were older than 40 years (mean age, 31.1 years). General anesthesia was induced in all cases before placement of a magnetic resonance imaging-compatible stereotactic frame. Electrode implantation was done under radioscopic control via a rigid immobile cannula using a single cerebral perforation. No perioperative microelectrode recording or neurostimulation testing was used. Systematic postoperative magnetic resonance imaging was performed before frame removal.


RESULTS
A total of 478 electrodes were implanted in 220 procedures: 426 for dystonic-dyskinetic syndromes and 52 for Parkinson disease. The mean number of parenchymal penetrations per patient was 2.5 for the dystonic-dyskinetic syndrome group and 2.08 for the Parkinson disease group. Postimplantation magnetic resonance imaging detected no perioperative intraparenchymal hemorrhages.


CONCLUSIONS
We consider that the risk of hemorrhagic complication is multifactorial but closely related to the chosen technique.
Maldonado
Igor Lima
IL
Department of Neurosurgery, Research Unit on Movement Disorders, University Hospital of Montpellier, Montpellier, France.
Roujeau
Thomas
T
Cif
Laura
L
Gonzalez
Victoria
V
El-Fertit
Hassan
H
Vasques
Xavier
X
Bonafe
Alain
A
Coubes
Phillippe
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D004567:Electrodes, Implanted / Q000009:adverse effects / Q000592:standards; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007431:Intraoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009069:Movement Disorders / Q000628:therapy*; D009434:Neural Pathways / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery; D038361:Neuronavigation / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D013238:Stereotaxic Techniques / Q000009:adverse effects; D055815:Young Adult