title: A detailed analysis of intracerebral hemorrhages in DBS surgeries.
abstract: OBJECTIVE
  Deep brain stimulation is nowadays a frequently performed surgery in patients with movement disorders, intractable epilepsy, and severe psychiatric disorders. The most feared complication of this surgery is an intracerebral hemorrhage due to the electrode placement, either for intraoperative electrophysiology (microelectrode recording) and/or implantation of the final electrode (macroelectrode). Here, we have investigated the risk of developing an intracerebral hemorrhage in our cohort of deep brain stimulation patients over a period of 15 years.
  
  
  METHODS
  We have collected demographic data and analyzed the effect of performing surgery with single-electrode versus multiple electrode guided DBS. The effect of using single-dose versus double-dose contrast enhanced MRI to visualize vessels for the electrode trajectory planning has been investigated as well.
  
  
  RESULTS
  We have found that the overall calculated risk of an intracerebral hemorrhage in our series was 1.81% per patient, 0.3% per recording electrode and 0.23% per brain insertion. While three out of four patients recovered without neurological deficits, there was one mortality in a patient with cardiovascular comorbidities. Statistical comparisons between the groups of single-electrode versus multiple electrode guided surgery and single-dose gadolinium versus double-dose contrast enhanced MRI revealed no significant differences. In addition, there was no meaningful correlation between the age at surgery and the risk of bleeding.
  
  
  CONCLUSIONS
  We have found that the risk of developing an intracerebral hemorrhage due to deep brain stimulation surgery is low. The clinical course of the patients with an intracerebral hemorrhage was generally favorable.
authors.affiliation: Department of Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands. Electronic address: tonge_m@yahoo.com.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Tonge
authors.affiliation: Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Linda
authors.initials: L
authors.lastname: Ackermans
authors.affiliation: Department of Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Neurosurgery, Ondokuz Mayis University, Samsun, Turkey.
authors.forename: Ersoy
authors.initials: E
authors.lastname: Kocabicak
authors.affiliation: Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Vivianne
authors.initials: V
authors.lastname: van Kranen-Mastenbroek
authors.affiliation: Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Mark
authors.initials: M
authors.lastname: Kuijf
authors.affiliation: Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Mayke
authors.initials: M
authors.lastname: Oosterloo
authors.affiliation: Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Pieter
authors.initials: P
authors.lastname: Kubben
authors.affiliation: Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands. Electronic address: y.temel@maastrichtuniversity.nl.
authors.forename: Yasin
authors.initials: Y
authors.lastname: Temel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000706:statistics & numerical data; D004567:Electrodes, Implanted / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012306:Risk; D055815:Young Adult
keywords: Complication; Contrast enhanced MRI; Deep brain stimulation; Electrode; Hemorrhage; Microelectrode recording