title: Clinical analysis and treatment of symptomatic intracranial hemorrhage after deep brain stimulation surgery.
abstract: BACKGROUND
  Symptomatic intracranial hemorrhage (ICH) may lead to permanent neurological disability of patients and has impeded the extensive clinical application of deep brain stimulation (DBS). The present study was conducted to discuss the incidence, prevention, and treatment of symptomatic ICH after DBS surgery.
  
  
  METHODS
  From January 2009 to December 2014, 396 patients underwent DBS with a total of 691 implanted leads. In all, 10 patients had symptomatic ICH. We analyzed these cases' clinical characteristics, including comorbid diagnoses and coagulation profile. We described the onset of ICH, imaging features, clinical manifestations, treatment, neurological impairment, and outcome of DBS.
  
  
  RESULTS
  Of the 10 patients with symptomatic ICH, 2 had hypertension. Three cases of ICH occurred within 12 h of the procedure; four cases within 24 h. Five experienced grand mal seizures concurrently with hemorrhage. Unilateral frontal lobe hemorrhage occurred in all cases. In seven cases, hematomas occurred around the electrodes. Some hematomas were not well-circumscribed and had perihematomal edema. Conservative therapy was administered to 8 patients, and 2 patients underwent craniotomy and hematoma evacuation. All electrodes were successfully preserved. Neurological dysfunction in all patients gradually improved. Nine patients ultimately experienced effective symptom relief of Parkinson's disease with DBS.
  
  
  CONCLUSIONS
  Symptomatic ICH should be identified as soon as possible after implantation surgery and treated effectively to limit neurological deficit and preserve DBS leads.
authors.affiliation: a Department of Neurosurgery , Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
authors.forename: Xin
authors.initials: X
authors.lastname: Wang
authors.affiliation: a Department of Neurosurgery , Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.affiliation: b Departmen of Neurosurgery , Second Affiliated Hospital, Xi'an Medical University , Xi'an , China.
authors.forename: Haikang
authors.initials: H
authors.lastname: Zhao
authors.affiliation: a Department of Neurosurgery , Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
authors.forename: Nan
authors.initials: N
authors.lastname: Li
authors.affiliation: a Department of Neurosurgery , Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
authors.forename: Shunnan
authors.initials: S
authors.lastname: Ge
authors.affiliation: a Department of Neurosurgery , Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
authors.affiliation: a Department of Neurosurgery , Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
authors.forename: Jiaming
authors.initials: J
authors.lastname: Li
authors.affiliation: a Department of Neurosurgery , Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
authors.forename: Jiangpeng
authors.initials: J
authors.lastname: Jing
authors.affiliation: a Department of Neurosurgery , Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
authors.forename: Mingming
authors.initials: M
authors.lastname: Su
authors.affiliation: a Department of Neurosurgery , Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
authors.forename: Zhaohui
authors.initials: Z
authors.lastname: Zheng
authors.affiliation: a Department of Neurosurgery , Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
authors.forename: Jinan
authors.initials: J
authors.lastname: Zhang
authors.affiliation: a Department of Neurosurgery , Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
authors.forename: Guodong
authors.initials: G
authors.lastname: Gao
authors.affiliation: a Department of Neurosurgery , Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
authors.forename: Xuelian
authors.initials: X
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001929:Brain Edema / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D002648:Child; D015897:Comorbidity; D003399:Craniotomy; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D004322:Drainage; D004567:Electrodes, Implanted / Q000009:adverse effects; D005260:Female; D005625:Frontal Lobe; D006801:Humans; D020299:Intracranial Hemorrhage, Hypertensive / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D020300:Intracranial Hemorrhages / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010300:Parkinson Disease / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D055815:Young Adult
keywords: Deep brain stimulation; Parkinson’s disease; clinical analysis; intracranial hemorrhage; treatment