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Sajonz BEA, Brugger TS, Reisert M, Büchsel M, Schröter N, Rau A, Egger K, Reinacher PC, Urbach H, Coenen VA, Kaller CP. Cerebral Intraparenchymal Hemorrhage due to Implantation of Electrodes for Deep Brain Stimulation: Insights from a Large Single-Center Retrospective Cross-Sectional Analysis. Brain Sci 2024; 14:612. [PMID: 38928612 PMCID: PMC11201406 DOI: 10.3390/brainsci14060612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Cerebral intraparenchymal hemorrhage due to electrode implantation (CIPHEI) is a rare but serious complication of deep brain stimulation (DBS) surgery. This study retrospectively investigated a large single-center cohort of DBS implantations to calculate the frequency of CIPHEI and identify patient- and procedure-related risk factors for CIPHEI and their potential interactions. We analyzed all DBS implantations between January 2013 and December 2021 in a generalized linear model for binomial responses using bias reduction to account for sparse sampling of CIPHEIs. As potential risk factors, we considered age, gender, history of arterial hypertension, level of invasivity, types of micro/macroelectrodes, and implanted DBS electrodes. If available, postoperative coagulation and platelet function were exploratorily assessed in CIPHEI patients. We identified 17 CIPHEI cases across 839 electrode implantations in 435 included procedures in 418 patients (3.9%). Exploration and cross-validation analyses revealed that the three-way interaction of older age (above 60 years), high invasivity (i.e., use of combined micro/macroelectrodes), and implantation of directional DBS electrodes accounted for 82.4% of the CIPHEI cases. Acquired platelet dysfunction was present only in one CIPHEI case. The findings at our center suggested implantation of directional DBS electrodes as a new potential risk factor, while known risks of older age and high invasivity were confirmed. However, CIPHEI risk is not driven by the three factors alone but by their combined presence. The contributions of the three factors to CIPHEI are hence not independent, suggesting that potentially modifiable procedural risks should be carefully evaluated when planning DBS surgery in patients at risk.
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Affiliation(s)
- Bastian E. A. Sajonz
- Department of Stereotactic and Functional Neurosurgery, Medical Center — University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Timo S. Brugger
- Department of Stereotactic and Functional Neurosurgery, Medical Center — University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Department of Neuroradiology, Medical Center — University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Institute for Evidence in Medicine, Medical Center — University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, 79110 Freiburg, Germany
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Medical Center — University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Medical Physics, Department of Radiology, Medical Center — University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Martin Büchsel
- Institute of Clinical Chemistry and Laboratory Medicine, Medical Center — University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Nils Schröter
- Department of Neurology, Medical Center — University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Alexander Rau
- Department of Neuroradiology, Medical Center — University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Karl Egger
- Department of Neuroradiology, Medical Center — University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Department of Radiology, Tauernklinikum, 5700 Zell am See, Austria
- Paracelsus Medical Private University (PMU), 5020 Salzburg, Austria
| | - Peter C. Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center — University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Fraunhofer Institute for Laser Technology (ILT), 52074 Aachen, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center — University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Volker A. Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center — University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Center for Deep Brain Stimulation, University of Freiburg, 79106 Freiburg, Germany
| | - Christoph P. Kaller
- Department of Neuroradiology, Medical Center — University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Freiburg Optical NeuroImaging [FrONI], Medical Center — University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
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Yaranagula SD, Kashyap M, Kola S, Kandadai RM, Alugolu R, Prasad V, Jasani GA, Borgohain R, Varma RD. Delayed Peri-Lead Intracerebral Hemorrhage Months after Deep Brain Stimulation: A Series of Two Patients. Ann Indian Acad Neurol 2024; 27:96-98. [PMID: 38495230 PMCID: PMC10941881 DOI: 10.4103/aian.aian_846_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/06/2023] [Accepted: 10/22/2023] [Indexed: 03/19/2024] Open
Affiliation(s)
- Sai Deepak Yaranagula
- Department of Neurology, Parkinson's Disease and Movement Disorder Research Centre, Banjara Hills, Hyderabad, Telangana, India
| | - Manshi Kashyap
- Department of Neurology, Parkinson's Disease and Movement Disorder Research Centre, Banjara Hills, Hyderabad, Telangana, India
| | - Sruthi Kola
- Department of Neurology, Parkinson's Disease and Movement Disorder Research Centre, Banjara Hills, Hyderabad, Telangana, India
| | - Rukmini Mridula Kandadai
- Department of Neurology, Parkinson's Disease and Movement Disorder Research Centre, Banjara Hills, Hyderabad, Telangana, India
| | - Rajesh Alugolu
- Department of Neurology, Parkinson's Disease and Movement Disorder Research Centre, Banjara Hills, Hyderabad, Telangana, India
| | - Vanakuru Prasad
- Department of Neurology, Parkinson's Disease and Movement Disorder Research Centre, Banjara Hills, Hyderabad, Telangana, India
| | | | - Rupam Borgohain
- Department of Neurology, Parkinson's Disease and Movement Disorder Research Centre, Banjara Hills, Hyderabad, Telangana, India
| | - Ravi Dandu Varma
- Department of Neuroradiology, Citi Neuro Centre, Banjara Hills, Hyderabad, Telangana, India
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Grofik M, Cibulka M, Olekšáková J, Turčanová Koprušáková M, Galanda T, Necpál J, Jungová P, Kurča E, Winkelmann J, Zech M, Jech R. A case of novel DYT6 dystonia variant with serious complications after deep brain stimulation therapy: a case report. BMC Neurol 2022; 22:344. [PMID: 36096774 PMCID: PMC9465909 DOI: 10.1186/s12883-022-02871-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/02/2022] [Indexed: 12/02/2022] Open
Abstract
Background DYT6 dystonia belongs to a group of isolated, genetically determined, generalized dystonia associated with mutations in the THAP1 gene. Case presentation We present the case of a young patient with DYT6 dystonia associated with a newly discovered c14G>A (p.Cys5Tyr) mutation in the THAP1 gene. We describe the clinical phenotype of this new mutation, effect of pallidal deep brain stimulation (DBS), which was accompanied by two rare postimplantation complications: an early intracerebral hemorrhage and delayed epileptic seizures. Among the published case reports of patients with DYT6 dystonia, the mentioned complications have not been described so far. Conclusions DBS in the case of DYT6 dystonia is a challenge to thoroughly consider possible therapeutic benefits and potential risks associated with surgery. Genetic heterogeneity of the disease may also play an important role in predicting the development of the clinical phenotype as well as the effect of treatment including DBS. Therefore, it is beneficial to analyze the genetic and clinical relationships of DYT6 dystonia.
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Affiliation(s)
- M Grofik
- Department of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital Martin, Martin, Slovakia
| | - M Cibulka
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovakia.
| | - J Olekšáková
- Department of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital Martin, Martin, Slovakia
| | - M Turčanová Koprušáková
- Department of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital Martin, Martin, Slovakia
| | - T Galanda
- Department of Neurosurgery, Slovak Medical University and Roosevelt Hospital, Banska Bystrica, Slovakia
| | - J Necpál
- Department of Neurology, Zvolen Hospital, Zvolen, Slovakia
| | - P Jungová
- Department of Molecular and Biochemical Genetics - Centre of Rare Genetic Diseases, Faculty of Medicine & Comenius University, University Hospital Bratislava, Bratislava, Slovakia
| | - E Kurča
- Department of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital Martin, Martin, Slovakia
| | - J Winkelmann
- Institute of Neurogenomics, Helmholtz Centrum, Munich, Germany.,Institute of Human Genetics, Technical University of Munich, Munich, Germany
| | - M Zech
- Department of Molecular and Biochemical Genetics - Centre of Rare Genetic Diseases, Faculty of Medicine & Comenius University, University Hospital Bratislava, Bratislava, Slovakia.,Institute of Neurogenomics, Helmholtz Centrum, Munich, Germany
| | - R Jech
- Department of Neurology, Charles University, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
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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.
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Walker RB, Grossen AA, O’Neal CM, Conner AK. Delayed hemorrhage following deep brain stimulation device placement in a patient with Parkinson’s disease and lupus anticoagulant syndrome: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 4:CASE2262. [PMID: 36046702 PMCID: PMC9301344 DOI: 10.3171/case2262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Treatment options for Parkinson’s disease (PD) include both medical and surgical approaches. Deep brain stimulation (DBS) is a surgical procedure that aims to improve motor symptomatology.
OBSERVATIONS
A 66-year-old White male with a 9-year history of PD presented to the neurosurgery clinic for DBS consideration. On the morning of scheduled surgery, preoperative laboratory test results revealed a prolonged prothrombin time of 50 seconds. Surgery was postponed, and further work-up revealed that the patient had a positive test result for lupus anticoagulant (LA). DBS implantation was performed 2 months later. The first stage of surgery was uneventful. The patient returned 1 week later for the second stage. Postoperatively, the patient exhibited a diminished level of consciousness. Computed tomography revealed left frontal intraparenchymal hemorrhage with surrounding edema, trace subarachnoid hemorrhage, intraventricular hemorrhage, and midline shift.
LESSONS
The authors suspect that the hemorrhage occurred secondary to venous infarct, because LA is associated with a paradoxically increased risk of thrombosis. Although there is no documented association between LA and acute or delayed hemorrhage, this case demonstrates a possible relationship in a patient following DBS placement. More research is needed to confirm an association with coexisting LA with PD and an increased hemorrhage risk in neurosurgical interventions.
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Affiliation(s)
- Robert B. Walker
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Audrey A. Grossen
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Christen M. O’Neal
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Andrew K. Conner
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Jung IH, Chang KW, Park SH, Chang WS, Jung HH, Chang JW. Complications After Deep Brain Stimulation: A 21-Year Experience in 426 Patients. Front Aging Neurosci 2022; 14:819730. [PMID: 35462695 PMCID: PMC9022472 DOI: 10.3389/fnagi.2022.819730] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDeep brain stimulation is an established treatment for movement disorders such as Parkinson’s disease, essential tremor, and dystonia. However, various complications that occur after deep brain stimulation are a major concern for patients and neurosurgeons.ObjectiveThis study aimed to analyze various complications that occur after deep brain stimulation.MethodsWe reviewed the medical records of patients with a movement disorder who underwent bilateral deep brain stimulation between 2000 and 2020. Among them, patients requiring revision surgery were analyzed.ResultsA total of 426 patients underwent bilateral deep brain stimulation for a movement disorder. The primary disease was Parkinson’s disease in 315 patients, followed by dystonia in 71 patients and essential tremor in 40 patients. Twenty-six (6.1%) patients had complications requiring revision surgery; the most common complication was infection (12 patients, 2.8%).ConclusionVarious complications may occur after deep brain stimulation, and patient prognosis should be improved by reducing complications.
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Affiliation(s)
- In-Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, South Korea
| | - Kyung Won Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - So Hee Park
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
- *Correspondence: Jin Woo Chang,
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Koh EJ, Golubovsky JL, Rammo R, Momin A, Walter B, Fernandez HH, Machado A, Nagel SJ. Estimating the Risk of Deep Brain Stimulation in the Modern Era: 2008 to 2020. Oper Neurosurg (Hagerstown) 2021; 21:277-290. [PMID: 34392372 DOI: 10.1093/ons/opab261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/16/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) was first approved by the United States Food and Drug Administration in 1997. Although the fundamentals of DBS remain the same, hardware, software, and imaging have evolved significantly. OBJECTIVE To test our hypothesis that the aggregate complication rate in the medical literature in the past 12 years would be lower than what is often cited based on early experience with DBS surgery. METHODS PubMed, PsycINFO, and EMBASE were queried for studies from 2008 to 2020 that included patients treated with DBS from 2007 to 2019. This yielded 34 articles that evaluated all complications of DBS surgery, totaling 2249 patients. RESULTS The overall complication rate in this study was 16.7% per patient. There was found to be a systemic complication rate of 0.89%, intracranial complication rate of 2.7%, neurological complication rate of 4.6%, hardware complication rate of 2.2%, and surgical site complication rate of 3.4%. The infection and erosion rate was 3.0%. CONCLUSION This review suggests that surgical complication rates have decreased since the first decade after DBS was first FDA approved. Understanding how to minimize complications from the inception of a technique should receive more attention.
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Affiliation(s)
- Eun Jeong Koh
- Department of Neurosurgery, Jeonbuk National University Medical School, Jeonju, Jeonbuk, Republic of Korea
| | - Joshua L Golubovsky
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Richard Rammo
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arbaz Momin
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Benjamin Walter
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hubert H Fernandez
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| | - Andre Machado
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sean J Nagel
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
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Horisawa S, Fukui A, Nonaka T, Kawamata T, Taira T. Radiofrequency Ablation for Movement Disorders: Risk Factors for Intracerebral Hemorrhage, a Retrospective Analysis. Oper Neurosurg (Hagerstown) 2021; 21:143-149. [PMID: 34098579 DOI: 10.1093/ons/opab169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 03/14/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND One of the greatest concerns associated with radiofrequency ablation is intracerebral hemorrhage (ICH). However, the majority of previous studies have mainly evaluated Parkinson disease patients with ablation of the globus pallidus internus (GPi). OBJECTIVE To investigate the hemorrhagic risk associated with radiofrequency ablation using ventro-oral (Vo) nucleus, ventral intermediate (Vim) nucleus, GPi, and pallidothalamic tract. METHODS Radiofrequency ablations for movement disorders from 2012 to 2019 at our institution were retrospectively analyzed. Multivariate analyses were performed to evaluate associations between potential risk factors and ICH. RESULTS A total of 558 patients underwent 721 stereotactic radiofrequency ablations for movement disorders. Among 558 patients, 356 had dystonia, 111 had essential tremor, and 51 had Parkinson disease. Among 721 procedures, the stereotactic targets used in this study were as follows: Vo: 230; Vim: 199; GPi: 172; pallidothalamic tract: 102; Vim/Vo: 18. ICH occurred in 37 patients (5.1%, 33 with dystonia and 4 with essential tremor). Symptomatic ICH developed in 3 Vo nuclei (1.3%), 3 Vim nuclei (1.5%), and 2 GPi (1.2%). Hypertension (odds ratio = 2.69, P = .0013), higher number of lesions (odds ratio = 1.23, P = .0221), and younger age (odds ratio = 1.04, P = .0055) were significant risk factors for ICH associated with radiofrequency ablation. CONCLUSION The present study revealed that younger age, higher number of lesions, and history of hypertension were independent risk factors for ICH associated with stereotactic radiofrequency ablation.
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Affiliation(s)
- Shiro Horisawa
- Department of Neurosurgery, Neurological Institute, TokyoWomen's Medical University, Tokyo, Japan
| | - Atsushi Fukui
- Department of Neurosurgery, Neurological Institute, TokyoWomen's Medical University, Tokyo, Japan
| | - Taku Nonaka
- Department of Neurosurgery, Neurological Institute, TokyoWomen's Medical University, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Neurological Institute, TokyoWomen's Medical University, Tokyo, Japan
| | - Takaomi Taira
- Department of Neurosurgery, Neurological Institute, TokyoWomen's Medical University, Tokyo, Japan
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Radziunas A, Deltuva VP, Tamasauskas A, Bunevicius A, Falowski S. Delayed intracerebral hemorrhage associated with placement of a deep brain stimulating electrode over two years prior. Int J Surg Case Rep 2021; 83:105969. [PMID: 34000489 PMCID: PMC8141757 DOI: 10.1016/j.ijscr.2021.105969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/04/2021] [Accepted: 05/08/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Most severe complications of DBS appear in the perioperative period. There are no published case reports of delayed ICH occurring more than three months from electrode implantation. The pathogenesis of delayed ICH remains unclear. CASE PRESENTATION We present a 64-year-old male with essential tremor who sustained a delayed intracerebral hemorrhage (ICH) 2.5 years after implantation of a deep brain stimulating electrode. DISCUSSION The patient sustained a thalamic-midbrain ICH that may have been related to the positioning of the electrode. An analysis was performed to determine the cause and risk factors that may have contributed. Based on these findings, it is possible that the proximity of the cannula or electrode may have mildly injured the wall of the superior thalamic vein during implantation, or perhaps being in contact with the vein over a longer-term having an effect, which in either of these scenarios can subsequently lead to ICH formation on the sudden rise of intracranial pressure. CONCLUSION It emphasizes the importance of proper surgical navigation planning, image- guidance, and the use of image verification.
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Affiliation(s)
- Andrius Radziunas
- Department of Neurosurgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Vytenis Pranas Deltuva
- Department of Neurosurgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Arimantas Tamasauskas
- Neuroscience Institute of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Adomas Bunevicius
- Neuroscience Institute of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Steven Falowski
- Department of Neurosurgery, Farber Institute for Neurosciences, Thomas Jefferson University, Philadelphia, PA, USA
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Isaacs BR, Keuken MC, Alkemade A, Temel Y, Bazin PL, Forstmann BU. Methodological Considerations for Neuroimaging in Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson's Disease Patients. J Clin Med 2020; 9:E3124. [PMID: 32992558 PMCID: PMC7600568 DOI: 10.3390/jcm9103124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/17/2020] [Accepted: 09/25/2020] [Indexed: 12/17/2022] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus is a neurosurgical intervention for Parkinson's disease patients who no longer appropriately respond to drug treatments. A small fraction of patients will fail to respond to DBS, develop psychiatric and cognitive side-effects, or incur surgery-related complications such as infections and hemorrhagic events. In these cases, DBS may require recalibration, reimplantation, or removal. These negative responses to treatment can partly be attributed to suboptimal pre-operative planning procedures via direct targeting through low-field and low-resolution magnetic resonance imaging (MRI). One solution for increasing the success and efficacy of DBS is to optimize preoperative planning procedures via sophisticated neuroimaging techniques such as high-resolution MRI and higher field strengths to improve visualization of DBS targets and vasculature. We discuss targeting approaches, MRI acquisition, parameters, and post-acquisition analyses. Additionally, we highlight a number of approaches including the use of ultra-high field (UHF) MRI to overcome limitations of standard settings. There is a trade-off between spatial resolution, motion artifacts, and acquisition time, which could potentially be dissolved through the use of UHF-MRI. Image registration, correction, and post-processing techniques may require combined expertise of traditional radiologists, clinicians, and fundamental researchers. The optimization of pre-operative planning with MRI can therefore be best achieved through direct collaboration between researchers and clinicians.
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Affiliation(s)
- Bethany R. Isaacs
- Integrative Model-based Cognitive Neuroscience Research Unit, University of Amsterdam, 1018 WS Amsterdam, The Netherlands; (A.A.); (P.-L.B.); (B.U.F.)
- Department of Experimental Neurosurgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands;
| | - Max C. Keuken
- Municipality of Amsterdam, Services & Data, Cluster Social, 1000 AE Amsterdam, The Netherlands;
| | - Anneke Alkemade
- Integrative Model-based Cognitive Neuroscience Research Unit, University of Amsterdam, 1018 WS Amsterdam, The Netherlands; (A.A.); (P.-L.B.); (B.U.F.)
| | - Yasin Temel
- Department of Experimental Neurosurgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands;
| | - Pierre-Louis Bazin
- Integrative Model-based Cognitive Neuroscience Research Unit, University of Amsterdam, 1018 WS Amsterdam, The Netherlands; (A.A.); (P.-L.B.); (B.U.F.)
- Max Planck Institute for Human Cognitive and Brain Sciences, D-04103 Leipzig, Germany
| | - Birte U. Forstmann
- Integrative Model-based Cognitive Neuroscience Research Unit, University of Amsterdam, 1018 WS Amsterdam, The Netherlands; (A.A.); (P.-L.B.); (B.U.F.)
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Helmers AK, Kubelt C, Birkenfeld F, Deuschl G, Falk D, Mehdorn H, Witt K, Nowak-Göttl U, Synowitz M, Paschen S. Screening for Platelet Dysfunction and Use of Prophylactic Tranexamic Acid in Patients Undergoing Deep Brain Stimulation: A Retrospective Analysis of Incidence and Outcome of Intracranial Hemorrhage. Stereotact Funct Neurosurg 2020; 98:176-181. [DOI: 10.1159/000505714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/30/2019] [Indexed: 11/19/2022]
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12
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Epilepsy: Neuromodulation. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Wojtasiewicz T, Butala A, Anderson WS. Dystonia. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Yang C, Qiu Y, Wang J, Wu Y, Hu X, Wu X. Intracranial hemorrhage risk factors of deep brain stimulation for Parkinson's disease: a 2-year follow-up study. J Int Med Res 2019; 48:300060519856747. [PMID: 31885350 PMCID: PMC7251548 DOI: 10.1177/0300060519856747] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective This study aimed to analyze the risk factors of intracranial hemorrhage (ICH) after deep brain stimulation (DBS) for idiopathic Parkinson’s disease (PD). Methods Patients who received DBS from March 2014 to December 2016 were retrospectively analyzed. The hemorrhage index was derived by combining the hemorrhagic volume and clinical manifestations of ICH. All patients with IHC were followed up for 2 years. Results Computed tomography showed 13 events of ICH in 11 patients (nine cases in the subthalamic nucleus), including eight cases with symptomatic hemorrhage (seven cases in the subthalamic nucleus). Hemorrhage was characterized by intracranial hematoma in the electrode puncture tract. Male sex and hypertension were significant risk factors for ICH. Hemorrhage in the preferred puncture side was significantly higher than that in the non-preferred puncture side. The mean hemorrhage index was 2.23 ± 0.83 in 11 patients, and no permanent neurological impairment was found during the 2-year follow-up. The effect of DBS on motor symptoms was similar in patients with and without ICH. Conclusion Male sex and hypertension are risk factors of ICH after DBS in PD. The risk of hemorrhage on the first puncture site is significantly higher than that on the second puncture site.
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Affiliation(s)
- Chunhui Yang
- Department of Neurosurgery, Changhai Hospital, Shanghai, China
| | - Yiqing Qiu
- Department of Neurosurgery, Changhai Hospital, Shanghai, China
| | - Jiali Wang
- Department of Neurosurgery, Changhai Hospital, Shanghai, China
| | - Yina Wu
- Department of Neurosurgery, Changhai Hospital, Shanghai, China
| | - Xiaowu Hu
- Department of Neurosurgery, Changhai Hospital, Shanghai, China
| | - Xi Wu
- Department of Neurosurgery, Changhai Hospital, Shanghai, China
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Bullard AJ, Hutchison BC, Lee J, Chestek CA, Patil PG. Estimating Risk for Future Intracranial, Fully Implanted, Modular Neuroprosthetic Systems: A Systematic Review of Hardware Complications in Clinical Deep Brain Stimulation and Experimental Human Intracortical Arrays. Neuromodulation 2019; 23:411-426. [DOI: 10.1111/ner.13069] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 08/05/2019] [Accepted: 09/10/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Autumn J. Bullard
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
| | | | - Jiseon Lee
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
| | - Cynthia A. Chestek
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
- Department of Electrical Engineering and Computer Science University of Michigan Ann Arbor MI USA
| | - Parag G. Patil
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
- Department of Neurosurgery University of Michigan Medical School Ann Arbor MI USA
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Koy A, Bockhorn N, Kühn A, Schneider GH, Krause P, Lauritsch K, Witt K, Paschen S, Deuschl G, Krauss J, Saryyeva A, Runge J, Borggraefe I, Mehrkens J, Horn A, Vesper J, Schnitzler A, Siegert S, Freilinger M, Eckenweiler M, Coenen V, Tadic V, Voges J, Pauls K, Wirths J, Timmermann L, Hellmich M, Abdallat M, Ascencao LC, Grünwald S, Wloch A, Schrader C, Groiss SJ, Wojtecki L. Adverse events associated with deep brain stimulation in patients with childhood-onset dystonia. Brain Stimul 2019; 12:1111-1120. [DOI: 10.1016/j.brs.2019.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/15/2019] [Accepted: 04/02/2019] [Indexed: 11/29/2022] Open
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Abstract
Deep brain stimulation is now the most common surgical treatment of tremor. Tremor can be classified as action or resting tremor and is one of the most common movement disorders. Initial treatment of tremor should focus on medical treatment but, if patients fail medical therapy, deep brain stimulation should be considered with likely success. The usual target is the ventral intermediate nucleus of the thalamus. Common side effects of treatment include paresthesias, dysarthria, and less often ataxia. Future directions of research and development, including directional leads and closed-loop stimulation, may eventually lead to additional improvement in patient outcomes.
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Affiliation(s)
- Wendell Lake
- University of Wisconsin-Madison, 600 Highland Avenue, Box 8660, Madison, WI 53792, USA
| | - Peter Hedera
- Vanderbilt University Medical Center, 645 21st Avenue South, Nashville, TN 37240, USA
| | - Peter Konrad
- Vanderbilt University Medical Center, Room 4333, VAV, 1500 21st Avenue, Nashville, TN 37212, USA.
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Sobstyl M, Aleksandrowicz M, Ząbek M, Pasterski T. Hemorrhagic complications seen on immediate intraprocedural stereotactic computed tomography imaging during deep brain stimulation implantation. J Neurol Sci 2019; 400:97-103. [PMID: 30909114 DOI: 10.1016/j.jns.2019.01.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 11/08/2018] [Accepted: 01/21/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND We present our operative experience of patients with movement disorders who developed intracerebral hemorrhage (ICH), which was identified on intraprocedural stereotactic computed tomography (CT) imaging performed immediately after deep brain stimulation (DBS) lead placement and prior to the implantation of further components of the DBS hardware. METHODS Patients who underwent DBS lead implantation from January 2009 through December 2017 were included in the present study. Most of the surgeries were performed in a staged fashion. All patients were operated using identical surgical and intraprocedural imaging techniques, and no microelectrode recordings were done. Leksell Stereotactic G frame and neuronavigation software was utilized for all surgeries. Intraprocedural stereotactic CT was performed to confirm the precise position of the implanted DBS lead and to rule out any hemorrhagic complications. RESULTS Overall, 222 patients underwent 322 DBS lead implantations during 316 stereotactic procedures. Six patients exhibited early ICH recognized on intraprocedural stereotactic CT performed immediately after DBS lead placement; in addition, two patients developed delayed ICH due to large venous infarction. Four patients with ICH were asymptomatic. The ICH rate was 2.5% per electrode and 3.6% per patient; the permanent deficit rate was 1.2% per electrode and 1.8% per patient. The death rate due to ICH in our cohort was 0.6% per electrode and 0.9% per patient. CONCLUSIONS Intraprocedural stereotactic CT can not only visualize the implanted DBS lead in the stereotactic space but also rule out early ICH. Identified predisposing factors for development of ICH include patient's age, hypertension, and previous antiplatelet therapy. Careful planning of stereotactic trajectories plays a paramount role in reducing the rate of ICH in DBS surgery.
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Affiliation(s)
- Michał Sobstyl
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Sobieskiego 9 Street, 02-957 Warsaw, Poland.
| | - Marta Aleksandrowicz
- Department of Neurosurgery, Bródno Mazovia Hospital, Warsaw, Poland, Kondratowicza 8 Street, 03-242 Warsaw, Poland
| | - Mirosław Ząbek
- Department of Neurosurgery, Bródno Mazovia Hospital, Warsaw, Poland, Kondratowicza 8 Street, 03-242 Warsaw, Poland
| | - Tomasz Pasterski
- Department of Neurosurgery, Bródno Mazovia Hospital, Warsaw, Poland, Kondratowicza 8 Street, 03-242 Warsaw, Poland
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Yin Z, Luo Y, Jin Y, Yu Y, Zheng S, Duan J, Xu R, Zhou D, Hong T, Lu G. Is awake physiological confirmation necessary for DBS treatment of Parkinson's disease today? A comparison of intraoperative imaging, physiology, and physiology imaging-guided DBS in the past decade. Brain Stimul 2019; 12:893-900. [PMID: 30876883 DOI: 10.1016/j.brs.2019.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is a well-established surgical therapy for Parkinson's disease (PD). Intraoperative imaging (IMG), intraoperative physiology (PHY) and their combination (COMB) are the three mainstream DBS guidance methods. OBJECTIVE To comprehensively compare the use of IMG-DBS, PHY-DBS and COMB-DBS in treating PD. METHODS PubMed, Embase, the Cochrane Library and OpenGrey were searched to identify PD-DBS studies reporting guidance techniques published between January 1, 2010, and May 1, 2018. We quantitatively compared the therapeutic effects, surgical time, target error and complication risk and qualitatively compared the patient experience, cost and technical prospects. A meta-regression analysis was also performed. This study is registered with PROSPERO, number CRD42018105995. RESULTS Fifty-nine cohorts were included in the main analysis. The three groups were equivalent in therapeutic effects and infection risks. IMG-DBS (p < 0.001) and COMB-DBS (p < 0.001) had a smaller target error than PHY-DBS. IMG-DBS had a shorter surgical time (p < 0.001 and p = 0.008, respectively) and a lower intracerebral hemorrhage (ICH) risk (p = 0.013 and p = 0.004, respectively) than PHY- and COMB-DBS. The use of intraoperative imaging and microelectrode recording correlated with a higher surgical accuracy (p = 0.018) and a higher risk of ICH (p = 0.049). CONCLUSIONS The comparison of COMB-DBS and PHY-DBS showed intraoperative imaging's superiority (higher surgical accuracy), while the comparison of COMB-DBS and IMG-DBS showed physiological confirmation's inferiority (longer surgical time and higher ICH risk). Combined with previous evidence, the use of intraoperative neuroimaging techniques should become a future trend.
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Affiliation(s)
- Zixiao Yin
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China; The First Clinical Medical College of Nanchang University, Nanchang, Jiangxi, PR China
| | - Yunyun Luo
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China; The First Clinical Medical College of Nanchang University, Nanchang, Jiangxi, PR China
| | - Yanwen Jin
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China; The Second Clinical Medical College of Nanchang University, Nanchang, Jiangxi, PR China
| | - Yaqing Yu
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China
| | - Suyue Zheng
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China
| | - Jian Duan
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China
| | - Renxu Xu
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China
| | - Dongwei Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China
| | - Tao Hong
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China
| | - Guohui Lu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China.
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Combination therapy of scalp electro-acupuncture and medication for the treatment of Parkinson's disease: A systematic review and meta-analysis. JOURNAL OF TRADITIONAL CHINESE MEDICAL SCIENCES 2019. [DOI: 10.1016/j.jtcms.2019.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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21
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Xu C, Mao G, Williamson R, Whiting D. Delayed intracerebral hemorrhage: A rare complication of deep brain stimulation surgery. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2018. [DOI: 10.1016/j.inat.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Experience Reduces Surgical and Hardware-Related Complications of Deep Brain Stimulation Surgery: A Single-Center Study of 181 Patients Operated in Six Years. PARKINSONS DISEASE 2018; 2018:3056018. [PMID: 30140425 PMCID: PMC6081564 DOI: 10.1155/2018/3056018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/23/2018] [Indexed: 12/18/2022]
Abstract
Objective Deep brain stimulation (DBS) surgery has increasingly been performed for the treatment of movement disorders and is associated with a wide array of complications. We aimed to present our experience and discuss strategies to minimize adverse events in light of this contemporary series and others in the literature. Methods A retrospective chart review was conducted to collect data on age, sex, indication, operation date, surgical technique, and perioperative and late complications. Results A total of 181 patients (113 males, 68 females) underwent DBS implantation surgery (359 leads) in the past six years. Indications and targets were as follows: Parkinson's disease (STN) (n=159), dystonia (GPi) (n=13), and essential tremor (Vim) (n=9). Mean age was 55.2 ± 11.7 (range 9-74) years. Mean follow-up duration was 3.4 ± 1.6 years. No mortality or permanent morbidity was observed. Major perioperative complications were confusion (6.6%), intracerebral hemorrhage (2.2%), stroke (1.1%), and seizures (1.1%). Long-term adverse events included wound (7.2%), mostly infection, and hardware-related (5.5%) complications. Among several factors, only surgical experience was found to be related with overall complication rates (early period: 31% versus late period: 10%; p=0.001). Conclusion The rates of both early and late complications of DBS surgery are acceptably low and decrease significantly with cumulative experience.
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Cho KH, Kim TH, Jung WS, Moon SK, Ko CN, Cho SY, Jeon CY, Choi TY, Lee MS, Lee SH, Chung EK, Kwon S. Pharmacoacupuncture for Idiopathic Parkinson's Disease: A Systematic Review of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2018; 2018:3671542. [PMID: 30046336 PMCID: PMC6036809 DOI: 10.1155/2018/3671542] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/03/2018] [Accepted: 04/17/2018] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Pharmacoacupuncture is a new acupuncture treatment that stimulates acupuncture points by injecting herbal medicine into them. Recently, pharmacoacupuncture has been widely used in the treatment of idiopathic Parkinson's disease in traditional East Asian medicine. The purpose of this systematic review is to evaluate the efficacy and safety of pharmacoacupuncture in the treatment of idiopathic Parkinson's disease. METHODS The following electronic databases were searched for studies published in or before December 2016: Medline, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, OASIS, and CNKI, without language restriction. The main outcome assessed was the total Unified Parkinson's Disease Rating Scale (UPDRS) score. The details of the pharmacoacupuncture intervention, such as the herbal medicine and acupuncture points used, were also investigated. RESULTS From 138 studies, 3 randomized controlled trials were included; the number of patients analyzed was 134. Most of the studies showed considerable methodological flaws. There was heterogeneity of the intervention type and treatment duration in the included studies. Therefore, we could not conduct a meta-analysis. In one study, adjunctive bee venom pharmacoacupuncture therapy significantly improved total UPDRS scores compared with conventional therapy alone. Another study, which used adjunctive Kakkonein pharmacoacupuncture, did not reveal significant improvement compared with conventional therapy alone. A third study reported that Mailuoning pharmacoacupuncture was able to significantly improve the modified Webster Symptom Score when compared with no treatment. Adverse events related to the pharmacoacupuncture were reported in only one case, itching caused by the bee venom. CONCLUSIONS Our findings regarding the efficacy of pharmacoacupuncture as a therapy for idiopathic Parkinson's disease are currently inconclusive. Further large and rigorous clinical trials are needed.
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Affiliation(s)
- Ki-Ho Cho
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Woo-Sang Jung
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sang-Kwan Moon
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Chang-Nam Ko
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seung-Yeon Cho
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Chan-Yong Jeon
- Department of Korean Internal Medicine, College of Korean Medicine, Gachon University, Seongnam, Republic of Korea
| | - Tae Young Choi
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Myeong Soo Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sang-Ho Lee
- Gangdong Mokhuri Oriental Medical Hospital, Department of Internal Medicine, Seoul, Republic of Korea
| | - Eun Kyoung Chung
- Division of Clinical Pharmacy, Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea
| | - Seungwon Kwon
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
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Abstract
INTRODUCTION Essential tremor is the most common form of pathologic tremor. Surgical therapies disrupt tremorogenic oscillation in the cerebellothalamocortical pathway and are capable of abolishing severe tremor that is refractory to available pharmacotherapies. Surgical methods are raspidly improving and are the subject of this review. Areas covered: A PubMed search on 18 January 2018 using the query essential tremor AND surgery produced 839 abstracts. 379 papers were selected for review of the methods, efficacy, safety and expense of stereotactic deep brain stimulation (DBS), stereotactic radiosurgery (SRS), focused ultrasound (FUS) ablation, and radiofrequency ablation of the cerebellothalamocortical pathway. Expert commentary: DBS and SRS, FUS and radiofrequency ablations are capable of reducing upper extremity tremor by more than 80% and are far more effective than any available drug. The main research questions at this time are: 1) the relative safety, efficacy, and expense of DBS, SRS, and FUS performed unilaterally and bilaterally; 2) the relative safety and efficacy of thalamic versus subthalamic targeting; 3) the relative safety and efficacy of atlas-based versus direct imaging tractography-based anatomical targeting; and 4) the need for intraoperative microelectrode recordings and macroelectrode stimulation in awake patients to identify the optimum anatomical target. Randomized controlled trials are needed.
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Affiliation(s)
- Rodger J Elble
- a Neuroscience Institute , Southern Illinois University School of Medicine , Springfield , Illinois , USA
| | - Ludy Shih
- b Department of Neurology , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , Massachusetts USA
| | - Jeffrey W Cozzens
- a Neuroscience Institute , Southern Illinois University School of Medicine , Springfield , Illinois , USA
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