Center for Neurological Restoration, Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Neurosurg. 2012 Mar;116(3):525-8. doi: 10.3171/2011.10.JNS11465. Epub 2011 Dec 2.
Many previous studies have shown that placement of deep brain stimulation (DBS) electrodes carries a considerable risk of hemorrhage. To date, no studies have evaluated the incidence of intracranial hemorrhage after removal of DBS electrodes. The authors performed a retrospective chart review to identify the incidence and trends in hemorrhage after DBS electrode removal.
A retrospective chart review of all DBS electrodes removed at the Cleveland Clinic between October 2000 and May 2010 was performed. All patients underwent postoperative CT scanning. Each patient was evaluated for age, sex, side of placement, target, duration of lead placement, reason for removal, and medical comorbidities.
A total of 78 lead removals were performed in the 10-year period (1300 leads were implanted during the same period). Of the 78 leads removed, 10 (12.8%) resulted in hemorrhages seen on postoperative CT scans. The hemorrhages were superficial cortical in 6 cases of lead removal (60%) and deep in 4 cases (40%). No statistically significant correlation to any of the factors evaluated was found. All hemorrhages were asymptomatic. The authors' retrospective study of 78 DBS lead removals revealed a high risk of intracranial hemorrhage (12.8% per lead). The risk of hemorrhage during removal is significantly greater than the risk of hemorrhage during implantation (2.0% per lead at the authors' center during the same period). There were more superficial hemorrhages, and all hemorrhages were asymptomatic.
Removal of DBS leads carries a significantly higher risk of postoperative hemorrhages that are seen on images but are not clinically symptomatic.
许多先前的研究表明，深部脑刺激（DBS）电极的放置存在相当大的出血风险。迄今为止，尚无研究评估 DBS 电极移除后颅内出血的发生率。作者进行了一项回顾性图表审查，以确定 DBS 电极移除后出血的发生率和趋势。
对 2000 年 10 月至 2010 年 5 月期间在克利夫兰诊所移除的所有 DBS 电极进行了回顾性图表审查。所有患者均接受术后 CT 扫描。对每位患者的年龄、性别、放置侧、目标、导联放置时间、移除原因和合并症进行评估。
在 10 年期间共进行了 78 次导联移除（同期植入了 1300 个导联）。在移除的 78 个导联中，有 10 个（12.8%）在术后 CT 扫描中发现有出血。6 例（60%）为导联移除后的浅表皮质出血，4 例（40%）为深部出血。未发现与任何评估因素有统计学显著相关性。所有出血均无症状。作者对 78 例 DBS 导联移除的回顾性研究显示颅内出血风险较高（每例 12.8%）。移除过程中的出血风险明显大于植入过程中的出血风险（同期作者中心每例 2.0%）。有更多的浅表性出血，所有的出血都是无症状的。
DBS 导联移除后有明显更高的术后出血风险，在影像学上可见，但无临床症状。
