An evaluation of hardware and surgical complications with deep brain stimulation based on diagnosis and lead location.
BACKGROUND
Deep brain stimulation is the most frequently performed neurosurgical procedure for movement disorders. This procedure is well tolerated, but not free of complications. Analysis of hardware complications based on patient diagnosis and lead location could prove valuable in recognizing potential pitfalls and patients at higher risk.


METHODS
This review analyzes the most common surgery-related complications that may occur based on diagnosis and lead location. Patients were categorized based on diagnosis - Parkinson's disease (PD), dystonia, and essential tremor (ET) - as well as by lead location - subthalamic nucleus (STN), globus pallidus interna (GPi), and ventral intermediate nucleus of the thalamus (Vim). It is a retrospective review of 326 patients undergoing 949 procedures over a 10-year period by one surgeon. Fisher's exact test and χ(2) test were employed and multivariate logistic regression analysis was performed to identify the significant variables of correlation.


RESULTS
Overall lead revision was observed at 5.7%, but was observed at 11.9% of GPi lead placements, and 10.7% of dystonia patients with only 4.6% of STN lead placements. Total extension revision was at 2.5%, but observed at 5.3% for dystonia patients and at only 1.4% for ET patients. Overall infection rate was at 1.9% with the highest rate observed in dystonia and ET patients. Postoperative complications with hardware, erosion, infection, and delayed stimulation failure were observed more often with ET and dystonia than with PD. This difference was statistically significant between dystonia and PD (p < 0.03) but not between the other disease entities (p > 0.05). On multivariate analysis, age and gender had no correlation with these complications. PD had significantly fewer complications on forward selection regression analysis (p = 0.004). Asymptomatic intracerebral hemorrhage was at 2.5% with the majority in Vim and none observed in GPi placements. There was only one symptomatic hemorrhage with a permanent deficit. Infarcts were observed at 0.8%. There were no mortalities.


CONCLUSIONS
This large series of patients and long-term follow-up demonstrate that risks of complications are not universal among movement disorder patients. Diagnosis and lead location are important risk stratification factors in determining complications.
Department of Neurosurgery, Rush University, Chicago, IL 60612, USA. steven_falowski@rush.edu
Steven
S
Falowski
Yinn Cher
YC
Ooi
Adam
A
Smith
Leonard
L
Verhargen Metman
Roy A E
RA
Bakay
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000601:surgery*; D002648:Child; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000601:surgery / Q000628:therapy*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies