Constantoyannis Constantine, Berk Caglar, Honey Christopher R, Mendez Ivar, Brownstone Robert M
Division of Neurosurgery at the University of British Columbia, Halifax, Canada.
Can J Neurol Sci. 2005 May;32(2):194-200. doi: 10.1017/s0317167100003966.
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.
The authors undertook a prospective analysis of their patients receiving this therapy in two Canadian centres, over a four-year period.
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.
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.
在全球范围内，深部脑刺激（DBS）越来越多地用于治疗帕金森病、肌张力障碍、震颤和疼痛。然而，与任何植入系统一样，DBS也带来了一系列与其硬件相关的新问题。感染、故障以及电极移位或断裂可能会增加患者的发病率，在评估这种治疗的风险/效益比时应予以考虑。这项研究强调了几个被认为会增加DBS硬件并发症的因素。
作者对在加拿大两个中心接受该治疗的患者进行了为期四年的前瞻性分析。
144例患者接受了204次永久性电极植入。平均随访时间为24个月。11例患者（7.6%）出现了与DBS硬件相关的并发症。有2例电极断裂（1.4%）和9例感染（6.2%），其中包括2例皮肤侵蚀（1.4%）。分期进行外置手术的患者感染风险显著更高。在头皮直切口的患者中，感染率高于弧形切口的患者。
硬件并发症并不常见。电极外置进行刺激试验的阶段与感染率增加有关。头皮直切口而非曲线切口也可能导致感染率上升。清楚了解公认的DBS设备适应症及其潜在并发症后，患者可以就DBS技术做出真正明智的决定。
