title: Postoperative displacement of deep brain stimulation electrodes related to lead-anchoring technique.
abstract: BACKGROUND
  Displacement of deep brain stimulation (DBS) electrodes may occur after surgery, especially due to large subdural air collections, but other factors might contribute.
  
  
  OBJECTIVE
  To investigate factors potentially contributing to postoperative electrode displacement, in particular, different lead-anchoring techniques.
  
  
  METHODS
  We retrospectively analyzed 55 patients (106 electrodes) with Parkinson disease, dystonia, tremor, and obsessive-compulsive disorder in whom early postoperative and long-term follow-up computed tomography (CT) was performed. Electrodes were anchored with a titanium microplate or with a commercially available plastic cap system. Two independent examiners determined the stereotactic coordinates of the deepest DBS contact on early postoperative and long-term follow-up CT. The influence of age, surgery duration, subdural air volume, use of microrecordings, fixation method, follow-up time, and side operated on first was assessed.
  
  
  RESULTS
  Subdural air collections measured on average 4.3 ± 6.2 cm. Three-dimensional (3-D) electrode displacement and displacement in the X, Y, and Z axes significantly correlated only with the anchoring method, with larger displacement for microplate-anchored electrodes. The average 3-D displacement for microplate-anchored electrodes was 2.3 ± 2.0 mm vs 1.5 ± 0.6 mm for electrodes anchored with the plastic cap (P = .030). Fifty percent of the microplate-anchored electrodes showed 2-mm or greater (potentially relevant) 3-D displacement vs only 25% of the plastic cap-anchored electrodes (P < .01).
  
  
  CONCLUSIONS
  The commercially available plastic cap system is more efficient in preventing postoperative DBS electrode displacement than titanium microplates. A reliability analysis of the electrode fixation is warranted when alternative anchoring methods are used.
authors.affiliation: Departments of †Neurology; ‡Neurosurgery; and §Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; ¶Department of Neurology, University Medical Centre Groningen, Groningen, the Netherlands.
authors.forename: M Fiorella
authors.initials: MF
authors.lastname: Contarino
authors.forename: Maarten
authors.initials: M
authors.lastname: Bot
authors.forename: Johannes D
authors.initials: JD
authors.lastname: Speelman
authors.forename: Rob M A
authors.initials: RM
authors.lastname: de Bie
authors.forename: Marina A
authors.initials: MA
authors.lastname: Tijssen
authors.forename: Damiaan
authors.initials: D
authors.lastname: Denys
authors.forename: Lo J
authors.initials: LJ
authors.lastname: Bour
authors.forename: P Richard
authors.initials: PR
authors.lastname: Schuurman
authors.forename: Pepijn
authors.initials: P
authors.lastname: van den Munckhof
mesh_terms: D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D004421:Dystonia / Q000628:therapy; D004567:Electrodes, Implanted / Q000009:adverse effects*; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000628:therapy; D010300:Parkinson Disease / Q000628:therapy; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D014202:Tremor / Q000628:therapy