Ben-Haim Sharona, Asaad Wael F, Gale John T, Eskandar Emad N
Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Neurosurgery. 2009 Apr;64(4):754-62; discussion 762-3. doi: 10.1227/01.NEU.0000339173.77240.34.
Hemorrhage is an infrequent but potentially devastating complication of deep brain stimulation (DBS) surgery. We examined the factors associated with hemorrhage after DBS surgery and evaluated a modified microelectrode design that may improve the safety of this procedure.
All microelectrode-guided DBS procedures performed at our institution between January 2000 and March 2008 were included in this study. A new microelectrode design with decreased diameter was introduced in May 2004, and data from the 2 types of electrodes were compared.
We examined 246 microelectrode-guided lead implantations in 130 patients. Postoperative imaging revealed 7 hemorrhages (2.8%). Five of the 7 (2.0%) resulted in focal neurological deficits, all of which resolved within 1 month with the exception of 1 patient lost to follow-up. The new microelectrode design significantly decreased the number of hemorrhages (P = 0.04). A surgical trajectory traversing the ventricle also contributed significantly to the overall hemorrhage rate (P = 0.02) and specifically to the intraventricular hemorrhage rate (P = 0.01). In addition, the new microelectrode design significantly decreased the rate of intraventricular hemorrhage, given a ventricular penetration (P = 0.01). The mean age of patients with hemorrhage was significantly higher than that of patients without hemorrhage (P = 0.02). Hypertension, sex, and number of microelectrodes passed did not significantly contribute to hemorrhage rates in our population.
The rate of complications after DBS surgery is not uniformly distributed across all cases. In particular, the rates of hemorrhage were increased in older patients. Importantly, transventricular electrode trajectories appeared to increase the risk of hemorrhage. A new microelectrode design minimizing the volume of brain parenchyma penetrated during microelectrode recording leads to decreased rates of hemorrhage, particularly if the ventricles are breached.
出血是脑深部电刺激（DBS）手术中一种少见但可能具有毁灭性的并发症。我们研究了与DBS手术后出血相关的因素，并评估了一种改良的微电极设计，该设计可能会提高此手术的安全性。
本研究纳入了2000年1月至2008年3月在我院进行的所有微电极引导下的DBS手术。2004年5月引入了一种直径减小的新型微电极设计，并对两种电极的数据进行了比较。
我们检查了130例患者的246次微电极引导下的导线植入。术后影像学检查发现7例出血（2.8%）。7例中的5例（2.0%）导致局灶性神经功能缺损，除1例失访患者外，所有患者均在1个月内恢复。新型微电极设计显著降低了出血数量（P = 0.04）。穿过脑室的手术轨迹也显著增加了总体出血率（P = 0.02），特别是脑室内出血率（P = 0.01）。此外，在发生脑室穿透的情况下，新型微电极设计显著降低了脑室内出血率（P = 0.01）。出血患者的平均年龄显著高于未出血患者（P = 0.02）。高血压、性别和通过的微电极数量对我们研究人群的出血率没有显著影响。
DBS手术后并发症的发生率在所有病例中并非均匀分布。特别是，老年患者的出血率增加。重要的是，经脑室电极轨迹似乎增加了出血风险。一种新型微电极设计可在微电极记录过程中减少脑实质的穿透体积，从而降低出血率，特别是在脑室被穿透的情况下。
Zotero 插件