title: Analysis of hemorrhagic risk factors during deep brain stimulation surgery for movement disorders: comparison of the circumferential paired and multiple electrode insertion methods.
abstract: BACKGROUND
  The most serious complication of deep brain stimulation (DBS) surgery is intracranial hemorrhage. The authors have assessed risk factors for hemorrhage in DBS surgery and compared two types of microelectrode insertion technique on hemorrhagic risk.
  
  
  METHODS
  A total of 171 DBS procedures were performed on 110 patients (58 females, 52 males) by the same neurosurgeon at a single center between May 2005 and May 2010. We used two microelectrode insertion methods: multiple microelectrode insertion (MMI) and circumferential paired microelectrode insertion (CPMI). We analyzed the correlation between bleeding rates and gender, age, hypertension, target location, simultaneous bilateral procedure and electrode insertion method.
  
  
  RESULTS
  Of the 171 DBS procedures, 138 were on 85 patients with Parkinson's disease, 16 were in 15 patients with essential tremor and 17 were on ten patients with dystonia. There were nine postoperative hemorrhagic events (5.26%), of which three were symptomatic (1.75%), and one permanent neurological deficit event (0.58%). Compared with the bleeding rate in the MMI method (9/106, 8.5%), there was no instance of bleeding with the CPMI method (0/65, 0%) (p = 0.04). In other factors, the correlation with hemorrhage was not found.
  
  
  CONCLUSIONS
  Use of the CPMI method significantly decreased the rate of bleeding. This new surgical technique seems to be safe and accurate and may be recommended as another surgical option.
authors.affiliation: Center for Parkinson and Alzheimer's Disease, Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea.
authors.forename: Jin Hoon
authors.initials: JH
authors.lastname: Park
authors.forename: Sun Ju
authors.initials: SJ
authors.lastname: Chung
authors.forename: Chong Sik
authors.initials: CS
authors.lastname: Lee
authors.forename: Sang Ryong
authors.initials: SR
authors.lastname: Jeon
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D004567:Electrodes, Implanted / Q000009:adverse effects* / Q000592:standards; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000150:complications* / Q000601:surgery* / Q000628:therapy; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors