Rolston John D, Englot Dario J, Starr Philip A, Larson Paul S
Department of Neurological Surgery, University of California, San Francisco, United States.
Department of Neurological Surgery, University of California, San Francisco, United States.
Parkinsonism Relat Disord. 2016 Dec;33:72-77. doi: 10.1016/j.parkreldis.2016.09.014. Epub 2016 Sep 12.
Deep brain stimulation (DBS) is an established therapy for movement disorders, and is under active investigation for other neurologic and psychiatric indications. While many studies describe outcomes and complications related to stimulation therapies, the majority of these are from large academic centers, and results may differ from those in general neurosurgical practice.
Using data from both the Centers for Medicare and Medicaid Services (CMS) and the National Surgical Quality Improvement Program (NSQIP), we identified all DBS procedures related to primary placement, revision, or removal of intracranial electrodes. Cases of cortical stimulation and stimulation for epilepsy were excluded.
Over 28,000 cases of DBS electrode placement, revision, and removal were identified during the years 2004-2013. In the Medicare dataset, 15.2% and of these procedures were for intracranial electrode revision or removal, compared to 34.0% in the NSQIP dataset. In NSQIP, significant predictors of revision and removal were decreased age (odds ratio (OR) of 0.96; 95% CI: 0.94, 0.98) and higher ASA classification (OR 2.41; 95% CI: 1.22, 4.75). Up to 48.5% of revisions may have been due to improper targeting or lack of therapeutic effect.
Data from multiple North American databases suggest that intracranial neurostimulation therapies have a rate of revision and removal higher than previously reported, between 15.2 and 34.0%. While there are many limitations to registry-based studies, there is a clear need to better track and understand the true prevalence and nature of such failures as they occur in the wider surgical community.
脑深部电刺激术（DBS）是一种已确立的治疗运动障碍的方法，目前正在积极研究其在其他神经和精神疾病适应症中的应用。虽然许多研究描述了与刺激疗法相关的结果和并发症，但其中大多数来自大型学术中心，其结果可能与一般神经外科实践中的结果不同。
利用医疗保险和医疗补助服务中心（CMS）以及国家外科质量改进计划（NSQIP）的数据，我们确定了所有与颅内电极初次植入、翻修或移除相关的DBS手术。排除了皮质刺激和癫痫刺激的病例。
在2004年至2013年期间，共确定了超过28000例DBS电极植入、翻修和移除病例。在医疗保险数据集里，这些手术中有15.2%是用于颅内电极翻修或移除，而在NSQIP数据集中这一比例为34.0%。在NSQIP中，翻修和移除的显著预测因素是年龄降低（比值比（OR）为0.96；95%置信区间：0.94，0.98）和较高的美国麻醉医师协会（ASA）分级（OR 2.41；95%置信区间：1.22，4.75）。高达48.5%的翻修可能是由于靶点定位不当或缺乏治疗效果。
来自多个北美数据库的数据表明，颅内神经刺激疗法的翻修和移除率高于先前报道，在15.2%至34.0%之间。虽然基于登记处的研究存在许多局限性，但显然有必要更好地跟踪和了解此类失败在更广泛的外科领域中的真实发生率和性质。
