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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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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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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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Mao G, Gigliotti MJ, Angle C, Whiting D, Tomycz N. Craniotomy for subdural hematoma after deep brain stimulation surgery: Outcomes and satisfaction in a case series of two patients. Clin Neurol Neurosurg 2018; 170:53-57. [PMID: 29729543 DOI: 10.1016/j.clineuro.2018.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/07/2018] [Accepted: 04/22/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine whether salvage of DBS hardware is beneficial for Parkinson's Disease (PD) patients by looking at follow-up patient's outcomes and satisfaction after their craniotomy operation. PATIENTS AND METHODS This was a retrospective review of a prospective, single-center deep brain stimulation (DBS) database between 2002-2016 identifying patients with PD who developed subdural hematomas (SDH) due to trauma after their DBS surgery. Of the 636 DBS cases that were performed, 3 PD-DBS patients with significant traumatic SDH managed via craniotomy were identified. Out of these 3 patients, only 2 permitted outcome analysis. At follow-up, functional and neurologic status, UPDRS motor score, and overall satisfaction with DBS were assessed. RESULTS Two patients were followed for a period of 10 and 9 months. At last follow-up, the DBS settings in patient 1 increased from a stimulation amplitude of 3.5 V to 4.5 V on the right and 3.3 V to 6.0 V on the left with an increase in the pulse width as well (70-80 ms and 80-140 ms on the right and left, respectively). Stimulation frequency remained 160 Hz on the right while increasing from 145 to 160 Hz on the left. Patient 2 experienced an increase in stimulation amplitude from 4.5 V to 4.8 V on the right while remaining the same on the left. Pulse width increased from 60 to 70 ms bilaterally as well as the frequency (160-185 Hz bilaterally). Despite craniotomy, both patients experienced substantial improvement in UPDRS motor score with DBS at last follow-up (53-25 and 20-17 for patient 1 and 2, respectively). At last follow-up, CT imaging provided evidence of complete SDH resolution with no persistent hemorrhage, mass effect or any obvious lead displacement. Patients expressed satisfaction with DBS and affirmed that they would undergo surgery again for the same outcome. CONCLUSION Patients with PD are at higher risk for falls and may experience an increased risk of falling associated with SDH in the post-operative period after DBS implantation. Despite brain shift from SDH potentially distorting DBS leads, DBS implants still provided significant benefit in patients requiring craniotomy for SDH and patient satisfaction with DBS remained high. Salvage of DBS hardware is recommended since significant symptomatic improvement with DBS programming may still be attainable even in the setting of emergent craniotomy for SDH.
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Affiliation(s)
- Gordon Mao
- Allegheny General Hospital, Department of Neurosurgery, 420 East North Avenue, Pittsburgh, PA, 15212, USA.
| | - Michael J Gigliotti
- Allegheny General Hospital, Department of Neurosurgery, 420 East North Avenue, Pittsburgh, PA, 15212, USA
| | - Cindy Angle
- Allegheny General Hospital, Department of Neurosurgery, 420 East North Avenue, Pittsburgh, PA, 15212, USA
| | - Donald Whiting
- Allegheny General Hospital, Department of Neurosurgery, 420 East North Avenue, Pittsburgh, PA, 15212, USA
| | - Nestor Tomycz
- Allegheny General Hospital, Department of Neurosurgery, 420 East North Avenue, Pittsburgh, PA, 15212, USA
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Richieri R, Borius PY, Cermolacce M, Millet B, Lançon C, Régis J. A Case of Recovery After Delayed Intracranial Hemorrhage After Deep Brain Stimulation for Treatment-Resistant Depression. Biol Psychiatry 2018; 83:e11-e13. [PMID: 28527567 DOI: 10.1016/j.biopsych.2017.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 04/19/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Raphaëlle Richieri
- Department of Psychiatry, Addictology and Child Psychiatry, La Conception University Hospital, Public Assistance Marseille Hospitals, Marseille, France; Health, Chronic Diseases and Quality of Life, EA 3279 Research Unit, Aix Marseille University, Marseille, France.
| | - Pierre-Yves Borius
- Department of Neurosurgery, Pitié-Salpétrière University Hospital, Public Assistance Paris Hospitals, Paris, France
| | - Michel Cermolacce
- Department of Psychiatry, Addictology and Child Psychiatry, La Conception University Hospital, Public Assistance Marseille Hospitals, Marseille, France
| | - Bruno Millet
- Department of Psychiatry, Pitié-Salpétrière University Hospital, Public Assistance Paris Hospitals, Paris, France
| | - Christophe Lançon
- Department of Psychiatry, Addictology and Child Psychiatry, La Conception University Hospital, Public Assistance Marseille Hospitals, Marseille, France; Health, Chronic Diseases and Quality of Life, EA 3279 Research Unit, Aix Marseille University, Marseille, France
| | - Jean Régis
- Department of Neurosurgery, La Timone Hospital, Public Assistance Marseille Hospitals, Marseille, France; Institut de Neurosciences des Systèmes, Institut National de la Santé et de la Recherche Médicale UMR 1106, Aix Marseille University, Marseille, France
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Cossu G, Sensi M. Deep Brain Stimulation Emergencies: How the New Technologies Could Modify the Current Scenario. Curr Neurol Neurosci Rep 2017; 17:51. [PMID: 28497305 DOI: 10.1007/s11910-017-0761-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
After 25 years of deep brain stimulation (DBS) for the treatment of Parkinson's disease, it has become increasingly recognized that a range of postoperative urgent situations and emergencies may occur. In this review we describe the possible scenarios of DBS-related emergencies: perioperative (intraoperative and early postoperative) and postoperative settings and issues from suboptimal control of motor and nonmotor symptoms in the early programming phase and during long-term follow-up. We also outline potential advantages in the management of these emergencies offered by the newest devices, emerging technologies, and new possibilities in programming.
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Affiliation(s)
- Giovanni Cossu
- Movement Disorders Unit, Department of Neurology, Brotzu General Hospital, Piazzale Ricchi 1, 09134, Cagliari, Italy.
| | - Mariachiara Sensi
- Department of Neurology, Azienda Ospedaliera Universitaria Arcispedale Sant'Anna, Ferrara, Italy
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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
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Panov F, Levin E, de Hemptinne C, Swann NC, Qasim S, Miocinovic S, Ostrem JL, Starr PA. Intraoperative electrocorticography for physiological research in movement disorders: principles and experience in 200 cases. J Neurosurg 2016; 126:122-131. [PMID: 26918474 DOI: 10.3171/2015.11.jns151341] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Contemporary theories of the pathophysiology of movement disorders emphasize abnormal oscillatory activity in basal ganglia-thalamocortical loops, but these have been studied in humans mainly using depth recordings. Recording from the surface of the cortex using electrocorticography (ECoG) provides a much higher amplitude signal than depth recordings, is less susceptible to deep brain stimulation (DBS) artifacts, and yields a surrogate measure of population spiking via "broadband gamma" (50-200 Hz) activity. Therefore, a technical approach to movement disorders surgery was developed that employs intraoperative ECoG as a research tool. METHODS One hundred eighty-eight patients undergoing DBS for the treatment of movement disorders were studied under an institutional review board-approved protocol. Through the standard bur hole exposure that is clinically indicated for DBS lead insertion, a strip electrode (6 or 28 contacts) was inserted to cover the primary motor or prefrontal cortical areas. Localization was confirmed by the reversal of the somatosensory evoked potential and intraoperative CT or 2D fluoroscopy. The ECoG potentials were recorded at rest and during a variety of tasks and analyzed offline in the frequency domain, focusing on activity between 3 and 200 Hz. Strips were removed prior to closure. Postoperative MRI was inspected for edema, signal change, or hematoma that could be related to the placement of the ECoG strip. RESULTS One hundred ninety-eight (99%) strips were successfully placed. Two ECoG placements were aborted due to resistance during the attempted passage of the electrode. Perioperative surgical complications occurred in 8 patients, including 5 hardware infections, 1 delayed chronic subdural hematoma requiring evacuation, 1 intraparenchymal hematoma, and 1 venous infarction distant from the site of the recording. None of these appeared to be directly related to the use of ECoG. CONCLUSIONS Intraoperative ECoG has long been used in neurosurgery for functional mapping and localization of seizure foci. As applied during DBS surgery, it has become an important research tool for understanding the brain networks in movement disorders and the mechanisms of therapeutic stimulation. In experienced hands, the technique appears to add minimal risk to surgery.
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Affiliation(s)
- Fedor Panov
- Department of Neurological Surgery, Mount Sinai School of Medicine, New York, New York
| | - Emily Levin
- Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan; and
| | | | | | | | | | - Jill L Ostrem
- Neurology, University of California, San Francisco, California
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Subacute Subdural Hematoma in a Patient with Bilateral DBS Electrodes. Case Rep Neurol Med 2016; 2015:390727. [PMID: 26779357 PMCID: PMC4686703 DOI: 10.1155/2015/390727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 12/03/2015] [Indexed: 11/28/2022] Open
Abstract
Subdural hematomas (SDH) in patients with implanted deep brain stimulating (DBS) electrodes are rare. Only a handful of cases have been reported in the literature. No clear management guidelines exist regarding the management of the hematoma and the existing electrodes. We describe a 68-year-old female with bilateral DBS electrodes, who presented with acute, severe hemiparesis due to a large subacute SDH with associated electrode displacement. Urgent hematoma evacuation reversed the hemiparesis; the electrodes were left undisturbed. Brain reexpansion occurred promptly. The patient was able to benefit from stable DBS therapies within 3 weeks of hematoma evacuation, maintained at 1.5-year follow-up. The case highlights that despite relative electrode migration due to a subdural hematoma, the electrodes may not require revision during initial hematoma evacuation or in a delayed fashion. Timely hematoma evacuation, coupled with brain reexpansion, may be adequate for the electrode to travel back to its original position and effect reasonable DBS therapies.
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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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Affiliation(s)
| | | | - Pierre-François D'Haese
- Department of Electrical Engineering & Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Srivatsan Pallavaram
- Department of Electrical Engineering & Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Chima Oluigbo
- Department of Neurological Surgery, Children's National Medical Center, Washington, DC, USA
| | - Punit Agrawal
- Department of Neurological Surgery, Center for Neuromodulation, Wexner Medical Center at the Ohio State University, Columbus, OH, USA
| | - Milind Deogaonkar
- Department of Neurology, Center for Neuromodulation, Wexner Medical Center at the Ohio State University, Columbus, OH, USA
| | - Ali Rezai
- Department of Neurology, Center for Neuromodulation, Wexner Medical Center at the Ohio State University, Columbus, OH, USA
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Chung EJ, Kim MS, Kim SJ. Delayed intracranial hemorrhage after deep brain stimulation in two Parkinson's disease patients. J Neurol Sci 2014; 342:202-3. [PMID: 24857355 DOI: 10.1016/j.jns.2014.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/24/2014] [Accepted: 05/09/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Eun Joo Chung
- Department of Neurology, Inje University College of Medicine, Busan, Republic of Korea
| | - Moo Seong Kim
- Department of Neurosurgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sang Jin Kim
- Department of Neurology, Inje University College of Medicine, Busan, Republic of Korea.
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