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Sharma M, Deogaonkar M. Accuracy and safety of targeting using intraoperative “O-arm” during placement of deep brain stimulation electrodes without electrophysiological recordings. J Clin Neurosci 2016; 27:80-6. [DOI: 10.1016/j.jocn.2015.06.036] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 06/16/2015] [Accepted: 06/20/2015] [Indexed: 10/22/2022]
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Bouton CE, Shaikhouni A, Annetta NV, Bockbrader MA, Friedenberg DA, Nielson DM, Sharma G, Sederberg PB, Glenn BC, Mysiw WJ, Morgan AG, Deogaonkar M, Rezai AR. Restoring cortical control of functional movement in a human with quadriplegia. Nature 2016; 533:247-50. [PMID: 27074513 DOI: 10.1038/nature17435] [Citation(s) in RCA: 461] [Impact Index Per Article: 57.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 02/15/2016] [Indexed: 12/30/2022]
Abstract
Millions of people worldwide suffer from diseases that lead to paralysis through disruption of signal pathways between the brain and the muscles. Neuroprosthetic devices are designed to restore lost function and could be used to form an electronic 'neural bypass' to circumvent disconnected pathways in the nervous system. It has previously been shown that intracortically recorded signals can be decoded to extract information related to motion, allowing non-human primates and paralysed humans to control computers and robotic arms through imagined movements. In non-human primates, these types of signal have also been used to drive activation of chemically paralysed arm muscles. Here we show that intracortically recorded signals can be linked in real-time to muscle activation to restore movement in a paralysed human. We used a chronically implanted intracortical microelectrode array to record multiunit activity from the motor cortex in a study participant with quadriplegia from cervical spinal cord injury. We applied machine-learning algorithms to decode the neuronal activity and control activation of the participant's forearm muscles through a custom-built high-resolution neuromuscular electrical stimulation system. The system provided isolated finger movements and the participant achieved continuous cortical control of six different wrist and hand motions. Furthermore, he was able to use the system to complete functional tasks relevant to daily living. Clinical assessment showed that, when using the system, his motor impairment improved from the fifth to the sixth cervical (C5-C6) to the seventh cervical to first thoracic (C7-T1) level unilaterally, conferring on him the critical abilities to grasp, manipulate, and release objects. This is the first demonstration to our knowledge of successful control of muscle activation using intracortically recorded signals in a paralysed human. These results have significant implications in advancing neuroprosthetic technology for people worldwide living with the effects of paralysis.
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Deogaonkar M, Sharma M, Oluigbo C, Nielson DM, Yang X, Vera-Portocarrero L, Molnar GF, Abduljalil A, Sederberg PB, Knopp M, Rezai AR. Spinal Cord Stimulation (SCS) and Functional Magnetic Resonance Imaging (fMRI): Modulation of Cortical Connectivity With Therapeutic SCS. Neuromodulation 2015; 19:142-53. [PMID: 26373920 DOI: 10.1111/ner.12346] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/03/2015] [Accepted: 08/05/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The neurophysiological basis of pain relief due to spinal cord stimulation (SCS) and the related cortical processing of sensory information are not completely understood. The aim of this study was to use resting state functional magnetic resonance imaging (rs-fMRI) to detect changes in cortical networks and cortical processing related to the stimulator-induced pain relief. METHODS Ten patients with complex regional pain syndrome (CRPS) or neuropathic leg pain underwent thoracic epidural spinal cord stimulator implantation. Stimulation parameters associated with "optimal" pain reduction were evaluated prior to imaging studies. Rs-fMRI was obtained on a 3 Tesla, Philips Achieva MRI. Rs-fMRI was performed with stimulator off (300TRs) and stimulator at optimum (Opt, 300 TRs) pain relief settings. Seed-based analysis of the resting state functional connectivity was conducted using seeds in regions established as participating in pain networks or in the default mode network (DMN) in addition to the network analysis. NCUT (normalized cut) parcellation was used to generate 98 cortical and subcortical regions of interest in order to expand our analysis of changes in functional connections to the entire brain. We corrected for multiple comparisons by limiting the false discovery rate to 5%. RESULTS Significant differences in resting state connectivity between SCS off and optimal state were seen between several regions related to pain perception, including the left frontal insula, right primary and secondary somatosensory cortices, as well as in regions involved in the DMN, such as the precuneus. In examining changes in connectivity across the entire brain, we found decreased connection strength between somatosensory and limbic areas and increased connection strength between somatosensory and DMN with optimal SCS resulting in pain relief. This suggests that pain relief from SCS may be reducing negative emotional processing associated with pain, allowing somatosensory areas to become more integrated into default mode activity. CONCLUSION SCS reduces the affective component of pain resulting in optimal pain relief. Study shows a decreased connectivity between somatosensory and limbic areas associated with optimal pain relief due to SCS.
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Scharpf DT, Sharma M, Deogaonkar M, Rezai A, Bergese SD. Practical considerations and nuances in anesthesia for patients undergoing deep brain stimulation implantation surgery. Korean J Anesthesiol 2015; 68:332-9. [PMID: 26257844 PMCID: PMC4524930 DOI: 10.4097/kjae.2015.68.4.332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 12/02/2022] Open
Abstract
The field of functional neurosurgery has expanded in last decade to include newer indications, new devices, and new methods. This advancement has challenged anesthesia providers to adapt to these new requirements. This review aims to discuss the nuances and practical issues that are faced while administering anesthesia for deep brain stimulation surgery.
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Sharma M, Deogaonkar M, Rezai A. Assessment of potential targets for deep brain stimulation in patients with Alzheimer's disease. J Clin Med Res 2015; 7:501-5. [PMID: 26015813 PMCID: PMC4432890 DOI: 10.14740/jocmr2127w] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 12/18/2022] Open
Abstract
Alzheimer’s disease (AD) is a progressive neurodegenerative disorder affecting 36 million people worldwide and 5.2 million in the United States. The pathogenesis of AD is still elusive. Accumulations of abnormal proteins (beta amyloid and tau protein), inflammatory cascades, abnormal responses to oxidative stress and alteration in oxidative metabolism have been implicated in AD. There are few effective therapeutic options available for this disorder at present. Neuromodulation offers a novel treatment modality for patients with AD. The databases of Medline and PubMed were searched for various studies in English literature describing the deep brain stimulation (DBS) in patients with AD. Various animal and human clinical studies have shown promising initial results with bilateral DBS targeting various anatomical nodes. In this review, we attempt to highlight the pathophysiology, neural circuitry and potential neuromodulation options in patients with AD. In appropriately selected patients, DBS can potentially delay the cognitive decline, enhance memory functions and can improve the overall quality of life. However, further randomized controlled trials are required to validate the efficacy of neuromodulation and to determine the most optimal target for AD.
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Sharma M, Rhiew R, Deogaonkar M, Rezai A, Boulis N. Accuracy and precision of targeting using frameless stereotactic system in deep brain stimulator implantation surgery. Neurol India 2015; 62:503-9. [PMID: 25387619 DOI: 10.4103/0028-3886.144442] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the accuracy of targeting using NexFrame frameless targeting system during deep brain stimulation (DBS) surgery. MATERIALS AND METHODS Fifty DBS leads were implanted in 33 patients using the NexFrame (Medtronic, Minneapolis, MN) targeting system. Postoperative thin cut CT scans were used for lead localization. X, Y, Z coordinates of the tip of the lead were calculated and compared with the intended target coordinates to assess the targeting error. Comparative frame-based data set was obtained from randomly selected 33 patients during the same period that underwent 65 lead placements using Leksell stereotactic frame. Euclidean vector was calculated for directional error. Multivariate analysis of variance was used to compare the accuracy between two systems. RESULTS The mean error of targeting using frameless system in medio-lateral plane was 1.4 mm (SD ± 1.3), in antero-posterior plane was 0.9 mm (SD ± 1.0) and in supero-inferior plane Z was 1.0 mm (SD ± 0.9). The mean error of targeting using frame-based system in medio-lateral plane was 1.0 mm (SD ± 0.7), in antero-posterior plane was 0.9 mm (SD ± 0.5) and in supero-inferior plane Z was 0.7 mm (SD ± 0.6). The error in targeting was significantly more (P = 0.03) in the medio-lateral plane using the frameless system as compared to the frame-based system. Mean targeting error in the Euclidean directional vector using frameless system was 2.2 (SD ± 1.6) and using frame-based system was 1.7 (SD ± 0.6) (P = 0.07). There was significantly more error in the first 25 leads placed using the frameless system than the second 25 leads (P = 0.0015). CONCLUSION The targeting accuracy of the frameless system was lower as compared to frame-based system in the medio-lateral direction. Standard deviations (SDs) were higher using frameless system as compared to the frame-based system indicating lower accuracy of this system. Error in targeting should be considered while using frameless stereotactic system for DBS implantation surgery.
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Sharma M, Deogaonkar M. Deep brain stimulation in Huntington's disease: assessment of potential targets. J Clin Neurosci 2015; 22:812-7. [PMID: 25698541 DOI: 10.1016/j.jocn.2014.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 11/02/2014] [Indexed: 01/17/2023]
Abstract
Huntington's disease (HD) is an autosomal-dominant neurodegenerative disorder that has very few effective therapeutic interventions. Since the disease has a defined neural circuitry abnormality, neuromodulation could be an option. Case reports, original research, and animal model studies were selected from the databases of Medline and PubMed. All related studies published up to July 2014 were included in this review. The following search terms were used: "Deep brain stimulation," "DBS," "thalamotomy," "pallidal stimulation," and "Huntington's Disease," "HD," "chorea," or "hyperkinetic movement disorders." This review examines potential nodes in the HD circuitry that could be modulated using deep brain stimulation (DBS) therapy. With rapid evolution of imaging and ability to reach difficult targets in the brain with refined DBS technology, some phenotypes of HD could potentially be treated with DBS in the near future. Further clinical studies are warranted to validate the efficacy of neuromodulation and to determine the most optimal target for HD.
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Zibly Z, Sharma M, Shaw A, Yeremeyeva E, Deogaonkar M, Rezai A. Deep brain stimulation (DBS), lead migration, and the stimloc cap: complication avoidance. Neurol India 2015; 62:703-4. [PMID: 25591702 DOI: 10.4103/0028-3886.149441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Shaw AB, Sharma M, Shaikhouni A, Marlin ES, Ikeda DS, McGregor JM, Deogaonkar M. Neuromodulation as a last resort option in the treatment of chronic daily headaches in patients with idiopathic intracranial hypertension. Neurol India 2015; 63:707-11. [PMID: 26448229 DOI: 10.4103/0028-3886.166534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the feasibility and efficacy of occipital nerve stimulation (ONS) in patients with refractory headaches secondary to idiopathic intracranial hypertension (IIH). BACKGROUND IIH is a syndrome characterized by elevated intracranial pressures in the absence of a mass lesion. These patients typically present with chronic and intractable headaches. Cerebrospinal fluid (CSF) diversion fails in relieving the headache in a significant proportion of this population. ONS has been shown to be effective in medically refractory headaches and to our knowledge, has not been attempted as a therapeutic modality in this population. METHODS Four patients with occipital predominant chronic daily headaches and IIH who failed medical management underwent bilateral ONSs. Octopolar percutaneous electrodes were implanted in the defined area of pain. Visual Analog Scale (VAS) was used as an outcome measure. Patient demographics and surgical complications were also reviewed in this retrospective study. Following the trial period, all patients had >50% pain reduction resulting in permanent implantation. RESULTS All 4 patients had an average improvement of their VAS scores by 75%, with 85% spatial coverage and the remainder of the uncovered region being frontal. Sustained benefits were seen up to 3 years of follow-up. One patient had a lead erosion requiring removal followed by delayed re-implantation and another lost treatment efficacy at 2 years resulting in explantation. One patient required CSF diversion due to visual threat during the follow-up period but maintained sustained benefit from her ONS. CONCLUSIONS Bilateral ONS may be a useful treatment option in the management of selected patients with IIH, after standard surgical interventions have been attempted. Bilateral ONS may provide therapeutic option for management of residual headaches in these complicated patients.
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Sharma M, Shaikhouni A, Saleh E, Shaw A, Deogaonkar M. Peripheral nerve field stimulation for otalgia: A novel therapy for refractory deep ear pain. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2014. [DOI: 10.1016/j.inat.2014.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Henderson EY, Goble T, D'Haese PF, Pallavaram S, Oluigbo C, Agrawal P, Deogaonkar M, Rezai A. Successful subthalamic nucleus deep brain stimulation therapy after significant lead displacement from a subdural hematoma. J Clin Neurosci 2014; 22:387-90. [PMID: 25304438 DOI: 10.1016/j.jocn.2014.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 07/28/2014] [Indexed: 10/24/2022]
Abstract
A 57-year-old man with a 21 year history of Parkinson's disease underwent bilateral subthalamic nucleus deep brain stimulation (DBS) placement. One week postoperatively he developed an acute left subdural hematoma from a fall with significant displacement of the DBS leads. It was promptly evacuated, the patient slowly recovered neurologically, and the leads again moved near to the original position. Six months of stimulation therapy attained 50% reduction in symptoms. This case report demonstrates the movement of DBS leads due to brain shift and their ability to come back to previous location once the brain shift is corrected.
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Sharma M, Shaw A, Deogaonkar M. Surgical Options for Complex Craniofacial Pain. Neurosurg Clin N Am 2014; 25:763-75. [DOI: 10.1016/j.nec.2014.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Amit A, Sharma M, Deogaonkar M. Peripheral nerve stimulation by 'sandwich' paddle leads: technical note. Acta Neurochir (Wien) 2014; 156:1987-9. [PMID: 25160853 DOI: 10.1007/s00701-014-2208-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 08/15/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Recently, there has been a burgeoning interest in the utility of peripheral nerve stimulation (PNS) for a variety of chronic focal neuropathic, musculoskeletal and visceral pain conditions. If the source of pain is directly related to a single peripheral nerve, surgical exposure and placing a paddle lead on the nerve are most effective. METHODS In this report, we describe a novel technique that optimizes the peripheral nerve stimulation by two paddle leads placed on either side of the nerve with their stimulating surfaces in contact with the nerve. After appropriate prepping and draping, the selected nerve is localized and circumferentially dissected free from the adjacent soft tissue. There should be enough length of nerve to accommodate two On-Point quadripolar leads (Medtronic, MN) along the length of the nerve in the same direction. RESULTS This 'sandwich' technique provides a wider interface of contacts with nerve fibers. It reduces the chance of migration and provides an opportunity for 'crosstalk.' CONCLUSION In selected cases where an open surgical PNS lead needs to be placed, the 'sandwich' technique can be used to augment the stimulation without additional morbidity. Although occasionally used in practice, this technique is still unreported.
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Shaw A, Sharma M, Deogaonkar M, Rezai A. Technological innovations in implants used for pain therapies. Neurosurg Clin N Am 2014; 25:833-42. [PMID: 25240670 DOI: 10.1016/j.nec.2014.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The field of pain management has experienced tremendous growth in implantable therapies secondary to the innovations of bioengineers, implanters, and industry. Every aspect of neuromodulation is amenable to innovation from implanting devices to anchors, electrodes, programming, and even patient programmers. Patients with previously refractory neuropathic pain syndromes have new and effective pain management strategies that are a direct result of innovations in implantable devices.
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Zibly Z, Shaw A, Harnof S, Sharma M, Graves C, Deogaonkar M, Rezai A. Modulation of mind: therapeutic neuromodulation for cognitive disability. J Clin Neurosci 2014; 21:1473-7. [DOI: 10.1016/j.jocn.2013.11.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 11/07/2013] [Accepted: 11/13/2013] [Indexed: 12/20/2022]
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Shaw A, Mohyeldin A, Zibly Z, Ikeda D, Deogaonkar M. Novel Tunneling System for Implantation of Percutaneous Nerve Field Stimulator Electrodes: A Technical Note. Neuromodulation 2014; 18:313-6; discussion 316. [DOI: 10.1111/ner.12224] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/21/2014] [Accepted: 05/23/2014] [Indexed: 11/28/2022]
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Abstract
Current data suggest that transcranial magnetic stimulation (TMS) has the potential to be an effective and complimentary treatment modality for patients with chronic neuropathic pain syndromes. The success of TMS for pain relief depends on the parameters of the stimulation delivered, the location of neural target, and duration of treatment. TMS can be used to excite or inhibit underlying neural tissue that depends on long-term potentiation and long-term depression, respectively. Long-term randomized controlled studies are warranted to establish the efficacy of repetitive TMS in patients with various chronic pain syndromes.
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Deogaonkar M, Oluigbo C, Nielson D, Yang X, Sharma M, Vera-Portocarrero L, Molnar G, Abduljalil A, Sederberg P, Rezai AR. 186 Spinal Cord Stimulation and Functional Magnetic Resonance Imaging. Neurosurgery 2014. [DOI: 10.1227/01.neu.0000452460.11538.d1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Deogaonkar M, Slavin KV. Peripheral Nerve/Field Stimulation for Neuropathic Pain. Neurosurg Clin N Am 2014; 25:1-10. [DOI: 10.1016/j.nec.2013.10.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Deogaonkar M, Zibly Z, Slavin KV. Spinal Cord Stimulation for the Treatment of Vascular Pathology. Neurosurg Clin N Am 2014; 25:25-31. [DOI: 10.1016/j.nec.2013.08.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Machado AG, Deogaonkar M, Cooper S. Deep brain stimulation for movement disorders: patient selection and technical options. Cleve Clin J Med 2012; 79 Suppl 2:S19-24. [PMID: 22761265 DOI: 10.3949/ccjm.79.s2a.04] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Deep brain stimulation (DBS) is used as a treatment for movement disorders. Unlike ablative procedures, DBS is reversible and adjustable. It is approved in the United States for treatment of Parkinson disease (PD), dystonia, and tremor. This surgical procedure is considered safe and effective for the management of the motor symptoms of these disorders, although it does not cure the underlying conditions. Potential complications of DBS surgery include intracranial hemorrhage, infections, and complications related to the hardware. There may also be complications related to stimulation or programming, although these are usually associated with dosages of dopaminergic medications and are reversible. DBS is usually performed under conscious sedation with awake evaluation during intraoperative physiologic testing. Typically, the procedure is performed with stereotactic image guidance, using computed tomography or magnetic resonance imaging (MRI) for targeting. Surgery can be accomplished with stereotactic frames or frameless systems. Recently, intraoperative MRI guidance has become available and is an alternative to the traditional surgical procedure, allowing for implantation of the DBS device under general anesthesia.
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Machado A, Fernandez HH, Deogaonkar M. Deep brain stimulation: what can patients expect from it? Cleve Clin J Med 2012; 79:113-20. [PMID: 22301561 DOI: 10.3949/ccjm.78gr.11006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Deep brain stimulation has largely replaced ablative procedures for the treatment of advanced Parkinson disease, essential tremor, and dystonia. It is also approved for obsessive-compulsive disorder. Although not curative, it improves symptoms and quality of life.
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Ghosh P, Machado A, Deogaonkar M, Ghosh D. Deep Brain Stimulation in Children with Dystonia: Experience from a Tertiary Care Center (IN10-2.002). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.in10-2.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ghosh P, Machado A, Deogaonkar M, Ghosh D. Deep Brain Stimulation in Children with Dystonia: Experience from a Tertiary Care Center (S28.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s28.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Liu JKC, Soliman H, Machado A, Deogaonkar M, Rezai AR. Intracranial hemorrhage after removal of deep brain stimulation electrodes. J Neurosurg 2012; 116:525-8. [DOI: 10.3171/2011.10.jns11465] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Many previous studies have shown that placement of deep brain stimulation (DBS) electrodes carries a considerable risk of hemorrhage. To date, no studies have evaluated the incidence of intracranial hemorrhage after removal of DBS electrodes. The authors performed a retrospective chart review to identify the incidence and trends in hemorrhage after DBS electrode removal.
Methods
A retrospective chart review of all DBS electrodes removed at the Cleveland Clinic between October 2000 and May 2010 was performed. All patients underwent postoperative CT scanning. Each patient was evaluated for age, sex, side of placement, target, duration of lead placement, reason for removal, and medical comorbidities.
Results
A total of 78 lead removals were performed in the 10-year period (1300 leads were implanted during the same period). Of the 78 leads removed, 10 (12.8%) resulted in hemorrhages seen on postoperative CT scans. The hemorrhages were superficial cortical in 6 cases of lead removal (60%) and deep in 4 cases (40%). No statistically significant correlation to any of the factors evaluated was found. All hemorrhages were asymptomatic. The authors' retrospective study of 78 DBS lead removals revealed a high risk of intracranial hemorrhage (12.8% per lead). The risk of hemorrhage during removal is significantly greater than the risk of hemorrhage during implantation (2.0% per lead at the authors' center during the same period). There were more superficial hemorrhages, and all hemorrhages were asymptomatic.
Conclusions
Removal of DBS leads carries a significantly higher risk of postoperative hemorrhages that are seen on images but are not clinically symptomatic.
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