Surgical and Hardware Complications of Deep Brain Stimulation—A Single Surgeon Experience of 519 Cases Over 20 Years

2021 ◽  
Author(s):  
Paresh K. Doshi ◽  
Neha Rai ◽  
Deepak Das
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Hardware Complications ◽  
Surgeon Experience ◽  
Deep Brain

scholarly journals Reducing Hardware-Related Complications of Deep Brain Stimulation

2005 ◽  
Vol 32 (2) ◽  
pp. 194-200 ◽  
Author(s):  
Constantine Constantoyannis ◽  
Caglar Berk ◽  
Christopher R. Honey ◽  
Ivar Mendez ◽  
Robert M. Brownstone
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Prospective Analysis ◽  
Clear Understanding ◽  
Risk Of Infection ◽  
Patient Morbidity ◽  
Hardware Complications ◽  
Scalp Incision ◽  
Deep Brain

ABSTRACT:Background:Deep brain stimulation (DBS) is used increasingly worldwide for the treatment of Parkinson's disease, dystonia, tremor and pain. As with any implanted system, however, DBS introduces a new series of problems related to its hardware. Infection, malfunction and lead migration or fracture may increase patient morbidity and should be considered when evaluating the risk/benefit ratio of this therapy. This work highlights several factors felt to increase DBS hardware complications.Methods:The authors undertook a prospective analysis of their patients receiving this therapy in two Canadian centres, over a four-year period.Results:One hundred and forty-four patients received 204 permanent electrode implants. The average follow-up duration was 24 months. Complications related to the DBS hardware were seen in 11 patients (7.6%). There were two lead fractures (1.4%) and nine infections (6.2%) including two erosions (1.4%). There was a significantly greater risk of infection in patients who underwent staged procedures with externalization. In patients with straight scalp incisions, the rate of infection was higher than that seen with curved incisions.Conclusion:Hardware complications were not common. A period of externalization of the electrodes for a stimulation trial was associated with an increased infection rate. It is also possible that a straight scalp incision instead of curvilinear incision may lead to an increase in the rate of infection. With a clear understanding of the accepted DBS device indications and their potential complications, patients may make a truly informed decision about DBS technology.

Deep brain stimulation hardware complications: The role of electrode impedance and current measurements

2008 ◽  
Vol 23 (5) ◽  
pp. 755-760 ◽  
Author(s):  
Sierra Farris ◽  
Jerrold Vitek ◽  
Monique L. Giroux
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Electrode Impedance ◽  
Hardware Complications ◽  
Deep Brain

Operative and hardware complications of deep brain stimulation for movement disorders

2006 ◽  
Vol 20 (5) ◽  
pp. 290-295 ◽  
Author(s):  
A. Paluzzi ◽  
A. Belli ◽  
P. Bain ◽  
X. Liu ◽  
T. M. Aziz
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Hardware Complications ◽  
Deep Brain

scholarly journals Implantable Pulse Generators for Deep Brain Stimulation: Challenges, Complications, and Strategies for Practicality and Longevity

2021 ◽  
Vol 15 ◽  
Author(s):  
Can Sarica ◽  
Christian Iorio-Morin ◽  
David H. Aguirre-Padilla ◽  
Ahmed Najjar ◽  
Michelle Paff ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Near Infrared ◽  
Electrode Materials ◽  
Pulse Generator ◽  
Field Potential ◽  
Invasive Treatment ◽  
Pulse Generators ◽  
Hardware Complications ◽  
Deep Brain

Deep brain stimulation (DBS) represents an important treatment modality for movement disorders and other circuitopathies. Despite their miniaturization and increasing sophistication, DBS systems share a common set of components of which the implantable pulse generator (IPG) is the core power supply and programmable element. Here we provide an overview of key hardware and software specifications of commercially available IPG systems such as rechargeability, MRI compatibility, electrode configuration, pulse delivery, IPG case architecture, and local field potential sensing. We present evidence-based approaches to mitigate hardware complications, of which infection represents the most important factor. Strategies correlating positively with decreased complications include antibiotic impregnation and co-administration and other surgical considerations during IPG implantation such as the use of tack-up sutures and smaller profile devices.Strategies aimed at maximizing battery longevity include patient-related elements such as reliability of IPG recharging or consistency of nightly device shutoff, and device-specific such as parameter delivery, choice of lead configuration, implantation location, and careful selection of electrode materials to minimize impedance mismatch. Finally, experimental DBS systems such as ultrasound, magnetoelectric nanoparticles, and near-infrared that use extracorporeal powered neuromodulation strategies are described as potential future directions for minimally invasive treatment.

Surgical and hardware complications in subthalamic nucleus deep brain stimulation

2007 ◽  
Vol 14 (7) ◽  
pp. 643-649 ◽  
Author(s):  
Yu-Cheng Chou ◽  
Shinn-Zong Lin ◽  
Wanhua Annie Hsieh ◽  
Sheng Huang Lin ◽  
Chao Chin Lee ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Hardware Complications ◽  
Deep Brain

Surgical and hardware complications of deep brain stimulation. A seven-year experience and review of the literature

2010 ◽  
Vol 152 (12) ◽  
pp. 2053-2062 ◽  
Author(s):  
Efstathios J. Boviatsis ◽  
Lampis C. Stavrinou ◽  
Marios Themistocleous ◽  
Andreas T. Kouyialis ◽  
Damianos E. Sakas
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Review Of The Literature ◽  
Hardware Complications ◽  
Deep Brain

Asleep deep brain stimulation with intraoperative magnetic resonance guidance: a single-institution experience

2021 ◽  
pp. 1-10
Author(s):  
David J. Segar ◽  
Nalini Tata ◽  
Maya Harary ◽  
Michael T. Hayes ◽  
G. Rees Cosgrove
Keyword(s):  
Deep Brain Stimulation ◽  
General Anesthesia ◽  
Brain Stimulation ◽  
Operative Time ◽  
Radial Error ◽  
Technical Accuracy ◽  
Lead Placement ◽  
Surgeon Experience ◽  
Deep Brain

OBJECTIVE Deep brain stimulation (DBS) is traditionally performed on an awake patient with intraoperative recordings and test stimulation. DBS performed under general anesthesia with intraoperative MRI (iMRI) has demonstrated high target accuracy, reduced operative time, direct confirmation of target placement, and the ability to place electrodes without cessation of medications. The authors describe their initial experience with using iMRI to perform asleep DBS and discuss the procedural and radiological outcomes of this procedure. METHODS All DBS electrodes were implanted under general anesthesia by a single surgeon by using a neuronavigation system with 3-T iMRI guidance. Clinical outcomes, operative duration, complications, and accuracy were retrospectively analyzed. RESULTS In total, 103 patients treated from 2015 to 2019 were included, and all but 1 patient underwent bilateral implantation. Indications included Parkinson’s disease (PD) (65% of patients), essential tremor (ET) (29%), dystonia (5%), and refractory epilepsy (1%). Targets included the globus pallidus pars internus (12.62% of patients), subthalamic nucleus (56.31%), ventral intermedius nucleus of the thalamus (30%), and anterior nucleus of the thalamus (1%). Technically accurate lead placement (radial error ≤ 1 mm) was obtained for 98% of leads, with a mean (95% CI) radial error of 0.50 (0.46–0.54) mm; all leads were placed with a single pass. Predicted radial error was an excellent predictor of real radial error, underestimating real error by only a mean (95% CI) of 0.16 (0.12–0.20) mm. Accuracy remained high irrespective of surgeon experience, but procedure time decreased significantly with increasing institutional and surgeon experience (p = 0.007), with a mean procedure duration of 3.65 hours. Complications included 1 case of intracranial hemorrhage (asymptomatic) and 1 case of venous infarction (symptomatic), and 2 patients had infection at the internal pulse generator site. The mean ± SD voltage was 2.92 ± 0.83 V bilaterally at 1-year follow-up. Analysis of long-term clinical efficacy demonstrated consistent postoperative improvement in clinical symptoms, as well as decreased drug doses across all indications and follow-up time points, including mean decrease in levodopa-equivalent daily dose by 53.57% (p < 0.0001) in PD patients and mean decrease in primidone dose by 61.33% (p < 0.032) in ET patients at 1-year follow-up. CONCLUSIONS A total of 205 leads were placed in 103 patients by a single surgeon under iMRI guidance with few operative complications. Operative time trended downward with increasing institutional experience, and technical accuracy of radiographic lead placement was consistently high. Asleep DBS implantation with iMRI appears to be a safe and effective alternative to standard awake procedures.

Deep Brain Stimulation Hardware Complications in Patients with Movement Disorders: Risk Factors and Clinical Correlations

2012 ◽  
Vol 90 (5) ◽  
pp. 300-306 ◽  
Author(s):  
José Fidel Baizabal Carvallo ◽  
Giovanni Mostile ◽  
Mike Almaguer ◽  
Anthony Davidson ◽  
Richard Simpson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Hardware Complications ◽  
Clinical Correlations ◽  
Deep Brain

Hardware complications in deep brain stimulation: Electrode impedance and loss of clinical benefit

2012 ◽  
Vol 18 (6) ◽  
pp. 765-769 ◽  
Author(s):  
Jorge Guridi ◽  
Maria C. Rodriguez-Oroz ◽  
Manuel Alegre ◽  
Jose A. Obeso
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Clinical Benefit ◽  
Electrode Impedance ◽  
Hardware Complications ◽  
Deep Brain Stimulation Electrode ◽  
Stimulation Electrode ◽  
Deep Brain
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