1
|
Optimized Deep Brain Stimulation Surgery to Avoid Vascular Damage: A Single-Center Retrospective Analysis of Path Planning for Various Deep Targets by MRI Image Fusion. Brain Sci 2022; 12:brainsci12080967. [PMID: 35892408 PMCID: PMC9332267 DOI: 10.3390/brainsci12080967] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022] Open
Abstract
Co-registration of stereotactic and preoperative magnetic resonance imaging (MRI) images can serve as an alternative for trajectory planning. However, the role of this strategy has not yet been proven by any control studies, and the trajectories of commonly used targets have not been systematically studied. The purpose of this study was to analyze the trajectories for various targets, and to assess the role of trajectories realized on fused images in preventing intracranial hemorrhage (ICH). Data from 1019 patients who underwent electrode placement for deep brain stimulation were acquired. Electrode trajectories were not planned for 396 patients, whereas trajectories were planned for 623 patients. Preoperative various MRI sequences and frame-placed MRI images were fused for trajectory planning. The patients’ clinical characteristics, the stereotactic systems, intracranial hemorrhage cases, and trajectory angles were recorded and analyzed. No statistically significant differences in the proportions of male patients, patients receiving local anesthesia, and diseases or target distributions (p > 0.05) were found between the trajectory planning group and the non-trajectory planning group, but statistically significant differences were observed in the numbers of both patients and leads associated with symptomatic ICH (p < 0.05). Regarding the ring and arc angle values, statistically significant differences were found among various target groups (p < 0.05). The anatomic structures through which leads passed were found to be diverse. Trajectory planning based on MRI fusion is a safe technique for lead placement. The electrode for each given target has its own relatively constant trajectory.
Collapse
|
2
|
Idiopathic delayed-onset oedema associated with deep brain stimulation. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
3
|
[Idiopathic delayed-onset edema associated with deep brain stimulation]. Neurologia 2020; 36:84-86. [PMID: 32192757 DOI: 10.1016/j.nrl.2020.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/27/2019] [Accepted: 02/08/2020] [Indexed: 11/23/2022] Open
|
4
|
Whiting AC, Catapano JS, Walker CT, Godzik J, Lambert M, Ponce FA. Peri-Lead Edema After Deep Brain Stimulation Surgery: A Poorly Understood but Frequent Complication. World Neurosurg 2018; 124:S1878-8750(18)32915-2. [PMID: 30594699 DOI: 10.1016/j.wneu.2018.12.092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/13/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Postoperative peri-lead edema (PLE) is a poorly understood complication of deep brain stimulation (DBS), which has been described sporadically in patients presenting with profound and often delayed symptoms. We performed a prospective evaluation of patients undergoing DBS to determine the frequency of and identify risk factors for PLE. METHODS Patients underwent DBS electrode placement by a single physician. Postoperative magnetic resonance imaging (MRI) was performed approximately 6 weeks after the operation in asymptomatic subjects and analyzed for presence of PLE. All symptomatic subjects underwent MRI at the time of presentation. Data regarding index disease, preoperative medical issues, operative technique, and intraoperative variables were collected and statistically analyzed. RESULTS A total of 191 leads were placed in 102 subjects; 15 patients (14.7%) demonstrated PLE. Seven patients (6.9%) presented with symptoms related to PLE, most often altered mental status or neurologic deficit. Many of the MRI findings were profound, with PLE sometimes several centimeters in diameter. No statistically significant difference was found between PLE-positive and normal subjects when analyzing multiple variables, including presence of vascular disease, hypertension, anticoagulant/antiplatelet use, electrode target, index disease, unilateral versus bilateral lead placement, number of brain penetrations, and presence or absence of microelectrode recording. CONCLUSIONS Patients with postoperative PLE can present with severe symptoms or can be asymptomatic and go undiagnosed. Because of the delayed-onset potential, PLE may be more common than previously reported. No clear risk factors have been identified; therefore, further studies and increased clinical vigilance are paramount for improving comprehension and possible prevention of PLE.
Collapse
Affiliation(s)
- Alexander C Whiting
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Corey T Walker
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Margaret Lambert
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Francisco A Ponce
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
| |
Collapse
|
5
|
Fernández-Pajarín G, Sesar A, Ares B, Relova JL, Arán E, Gelabert-González M, Castro A. Delayed complications of deep brain stimulation: 16-year experience in 249 patients. Acta Neurochir (Wien) 2017. [PMID: 28646465 DOI: 10.1007/s00701-017-3252-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Over the years, most of the deep brain stimulation (DBS) complications described have been mainly related to the surgery itself or the stimulation. Only a few authors have dealt with chronic complications or complications due to implanted material. METHODS We retrospectively analyzed complications beyond the 1st month after surgery in 249 patients undergoing DBS at our site for 16 years, with 321 interventions overall. RESULTS Our results show that infection is the most frequent delayed complication (12.5%), the pulse generator being the most common location. Lead breaks (9.3%) are the second most frequent complication. Symptomatic peri-lead edema and cyst formation were exceptional. CONCLUSIONS The best knowledge about DBS complications allows for better solutions. In case of infection, conservative treatment or partial removal of the DBS system appears to be safe and reasonable. Intracranial complications related to DBS material such as peri-lead edema and cyst formation have a good prognosis. They may appear long after DBS implantation.
Collapse
Affiliation(s)
| | - A Sesar
- Department of Neurology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - B Ares
- Department of Neurology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - J L Relova
- Department of Neurophysiology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - E Arán
- Department of Neurosurgery, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - M Gelabert-González
- Department of Neurosurgery, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - A Castro
- Department of Neurology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| |
Collapse
|
6
|
Dietvorst S, Decramer T, Lemmens R, Morlion B, Nuttin B, Theys T. Pocket Pain and Neuromodulation: Negligible or Neglected? Neuromodulation 2017; 20:600-605. [PMID: 28699685 DOI: 10.1111/ner.12637] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/19/2017] [Accepted: 06/02/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Pain encountered at the site of the implantable pulse generator (IPG) after invasive neuromodulation is a well-known and important complication. The reported incidence of implant site pain is variable, ranging between 0.4 and 35%. Implant site pain has never been systematically studied and no treatment guidelines are available. MATERIAL AND METHODS We performed an observational study (study registration number mp05728) on the incidence and the determining factors of implant site pain, the subjective rating of intensity by sending questionnaires (n = 554) to our cohort of neuromodulation patients with IPGs. The number of revision surgeries and explants due to implant site pain were also analyzed. RESULTS Total response rate was 50% (n = 278). Pain patients suffered significantly (p < 0.05) more often from IPG site pain than other patients undergoing neuromodulation therapies. Up to 64% of patients undergoing spinal cord stimulation reported IPG site discomfort or pain. Severe pocket pain was found in up to 8% of patients. No association was found between other variables (age, BMI, duration of follow-up, gender, smoking, number of pocket surgeries) and implant site pain. CONCLUSION Pocket pain represents an important problem after invasive neuromodulation and is more prevalent in pain patients. We believe further technological improvements with miniaturized IPGs will impact the incidence of pocket pain and could even obviate the need for an IPG pocket.
Collapse
Affiliation(s)
- Sofie Dietvorst
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Decramer
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium.,Experimental Neurosurgery & Neuroanatomy, KU Leuven, Leuven, Belgium
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Morlion
- Leuven Centre for Algology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Nuttin
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium.,Experimental Neurosurgery & Neuroanatomy, KU Leuven, Leuven, Belgium
| | - Tom Theys
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium.,Experimental Neurosurgery & Neuroanatomy, KU Leuven, Leuven, Belgium
| |
Collapse
|
7
|
Pepper J, Meliak L, Akram H, Hyam J, Milabo C, Candelario J, Foltynie T, Limousin P, Curtis C, Hariz M, Zrinzo L. Changing of the guard: reducing infection when replacing neural pacemakers. J Neurosurg 2017; 126:1165-1172. [DOI: 10.3171/2016.4.jns152934] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Infection of deep brain stimulation (DBS) hardware has a significant impact on patient morbidity. Previous experience suggests that infection rates appear to be higher after implantable pulse generator (IPG) replacement surgery than after the de novo DBS procedure. In this study the authors examine the effect of a change in practice during DBS IPG replacements at their institution.
METHODS
Starting in January 2012, patient screening for methicillin-resistant Staphylococcus aureus (MRSA) and, and where necessary, eradication was performed prior to elective DBS IPG change. Moreover, topical vancomycin was placed in the IPG pocket during surgery. The authors then prospectively examined the infection rate in patients undergoing DBS IPG replacement at their center over a 3-year period with at least 9 months of follow-up.
RESULTS
The total incidence of infection in this prospective consecutive series of 101 IPG replacement procedures was 0%, with a mean follow-up duration of 24 ± 11 months. This was significantly lower than the authors' previously published historical control group, prior to implementing the change in practice, where the infection rate for IPG replacement was 8.5% (8/94 procedures; p = 0.003).
CONCLUSIONS
This study suggests that a change in clinical practice can significantly lower infection rates in patients undergoing DBS IPG replacement. These simple measures can minimize unnecessary surgery, loss of benefit from chronic stimulation, and costly hardware replacement, further improving the cost efficacy of DBS therapies.
Collapse
Affiliation(s)
- Joshua Pepper
- 1Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London
| | - Lara Meliak
- 1Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London
| | - Harith Akram
- 1Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London
| | - Jonathan Hyam
- 1Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London
- 2Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London
| | - Catherine Milabo
- 1Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London
| | - Joseph Candelario
- 1Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London
| | - Thomas Foltynie
- 1Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London
| | - Patricia Limousin
- 1Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London
| | - Carmel Curtis
- 3Department of Clinical Microbiology, University College London Hospital, London, United Kingdom; and
| | - Marwan Hariz
- 1Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London
- 4Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Ludvic Zrinzo
- 1Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London
- 2Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London
| |
Collapse
|
8
|
Wang X, Wang J, Zhao H, Li N, Ge S, Chen L, Li J, Jing J, Su M, Zheng Z, Zhang J, Gao G, Wang X. Clinical analysis and treatment of symptomatic intracranial hemorrhage after deep brain stimulation surgery. Br J Neurosurg 2016; 31:217-222. [PMID: 27760466 DOI: 10.1080/02688697.2016.1244252] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Xin Wang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jing Wang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Haikang Zhao
- Departmen of Neurosurgery, Second Affiliated Hospital, Xi’an Medical University, Xi’an, China
| | - Nan Li
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Shunnan Ge
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Lei Chen
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jiaming Li
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jiangpeng Jing
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Mingming Su
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhaohui Zheng
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jinan Zhang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Guodong Gao
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Xuelian Wang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| |
Collapse
|
9
|
Rolston JD, Ramos AD, Heath S, Englot DJ, Lim DA. Thalamotomy-Like Effects From Partial Removal of a Ventral Intermediate Nucleus Deep Brain Stimulator Lead in a Patient With Essential Tremor: Case Report. Neurosurgery 2016. [PMID: 26200771 DOI: 10.1227/neu.0000000000000906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE The ventral intermediate nucleus of the thalamus is a primary target of deep brain stimulation (DBS) in patients with essential tremor. Despite reliable control of contralateral tremor, there is sometimes a need for lead revision in cases of infection, hardware malfunction, or failure to relieve symptoms. Here, we present the case of a patient undergoing revision after ventral intermediate nucleus (Vim) DBS failed to control his tremor. During the electrode removal, the distal portion of the lead was found to be tightly adherent to tissue within the deep brain. Partial removal of the electrode in turn caused weakness, paresthesias, and tremor control similar to the effects produced by thalamotomy or thalamic injury. CLINICAL PRESENTATION A 48-year-old man with essential tremor had bilateral Vim DBS leads implanted 10 years earlier but had poor control of his tremor and ultimately opted for surgical revision with lead placement in the zona incerta. During attempted removal of his right lead, the patient became somnolent with contralateral weakness and paresthesias. The procedure was aborted, and postoperative neuroimaging was immediately obtained, showing no signs of stroke or hemorrhage. The patient had almost complete control of his left arm tremor postoperatively, and his weakness soon resolved. CONCLUSION To the best of our knowledge, this is the first reported case of cerebral injury after DBS revision and offers insights into the mechanism of high-frequency electric stimulation compared with lesions. That is, although high-frequency stimulation failed to control this patient's tremor, thalamotomy-like injury was completely effective.
Collapse
Affiliation(s)
- John D Rolston
- *Department of Neurological Surgery, University of California, San Francisco, California; ‡San Francisco VA Parkinson's Disease Research, Education, & Clinical Center and §Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | | | | | | | | |
Collapse
|
10
|
Sharma VD, Bona AR, Mantovani A, Miocinovic S, Khemani P, Goldberg MP, Foote KD, Whitworth LA, Chitnis S, Okun MS. Cystic Lesions as a Rare Complication of Deep Brain Stimulation. Mov Disord Clin Pract 2015; 3:87-90. [PMID: 30363583 DOI: 10.1002/mdc3.12230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/10/2015] [Accepted: 07/05/2015] [Indexed: 11/12/2022] Open
Abstract
DBS is a typically well-tolerated operation for treatment of Parkinson's disease, dystonia, and essential tremor (ET). Complications related to the surgical procedure and implanted hardware may occur. More commonly reported complications include hemorrhage, seizure, confusion, and infection. In this article, we report on a rare, but important, complication of DBS surgery, a brain cyst formation at the tip of the implanted ventralis intermedius nucleus (VIM) DBS lead in 2 patients who underwent the procedure at 2 different centers. The indication for surgery was debilitating ET, and in both cases, there was development of a delayed-onset neurological deficit associated with an internal capsule/thalamic cystic lesion formation located at the tip of the DBS lead. Case 1 presented within a few months post-DBS, whereas case 2 had a 10-mo delay to onset of symptoms. No clinical and radiological signs of infection were observed and both DBS systems were explanted with uneventful recovery.
Collapse
Affiliation(s)
- Vibhash D Sharma
- Department of Neurology Emory University School of Medicine Atlanta Georgia USA
| | - Alberto R Bona
- Center for Movement Disorders and Neurorestoration University of Florida Gainesville Florida USA
| | - Alessandra Mantovani
- Center for Movement Disorders and Neurorestoration University of Florida Gainesville Florida USA
| | | | - Pravin Khemani
- Department of Neurology and Neurotherapeuthics UT Southwestern Medical Center Dallas Texas USA
| | - Mark P Goldberg
- Department of Neurology and Neurotherapeuthics UT Southwestern Medical Center Dallas Texas USA
| | - Kelly D Foote
- Center for Movement Disorders and Neurorestoration University of Florida Gainesville Florida USA
| | - Louis A Whitworth
- Department of Neurology and Neurotherapeuthics UT Southwestern Medical Center Dallas Texas USA
| | - Shilpa Chitnis
- Department of Neurology and Neurotherapeuthics UT Southwestern Medical Center Dallas Texas USA
| | - Michael S Okun
- Center for Movement Disorders and Neurorestoration University of Florida Gainesville Florida USA
| |
Collapse
|