Park Chang Kyu, Jung Na Young, Kim Minsoo, Chang Jin Woo
Department of Neurosurgery, Severance Hospital, Brain Research Institute, Yonsei University, College of Medicine, Seoul, Korea.
Department of Neurosurgery, Severance Hospital, Brain Research Institute, Yonsei University, College of Medicine, Seoul, Korea.
World Neurosurg. 2017 Aug;104:537-544. doi: 10.1016/j.wneu.2017.05.075. Epub 2017 May 20.
Deep brain stimulation (DBS) may cause various complications including intracerebral hemorrhage (ICH). Because ICH causes devastating neurologic outcomes, various surgical techniques are attempting to reduce the chances of ICH. More importantly, early detection and proper management of postoperative ICH are indispensable. ICH may occur immediately or delayed following DBS; in this study, we analyzed the clinical features of delayed ICH after DBS.
Patients (n = 272) underwent postoperative brain computed tomography (CT) immediately after and 1 day after DBS between January 2008 and November 2016. Among these patients, 136 patients had Parkinson disease, 54 suffered from dystonia, 47 presented with essential tremor, and 9 had obsessive-compulsive disorder.
Out of the 272 patients who underwent 448 DBS lead implantations, 13 patients showed postoperative ICH. The ICH rate was 2.9% per lead and 4.77% per patient during the study period. Three patients (1.1%) demonstrated ICH immediately after DBS, and 10 patients (3.7%) demonstrated delayed ICH. Among them, only 1 patient showed large ICH (30 cm) with elevation of intracranial pressure, subsequently undergoing ICH removal surgery and recovering without permanent neurologic deficits. The other 12 patients demonstrated small ICH (1-10 cm). None of the patients with ICH demonstrated permanent disability.
Our study demonstrates that delayed ICH can occur after DBS even with normal brain CT immediately after DBS. Because ICH can cause serious neurological sequelae, the possibility of delayed ICH after DBS should be considered for the optimal management of patients.
脑深部电刺激术（DBS）可能导致包括脑出血（ICH）在内的各种并发症。由于脑出血会导致严重的神经功能后果，各种手术技术都在试图降低脑出血的发生率。更重要的是，术后脑出血的早期检测和妥善处理必不可少。脑出血可能在DBS术后立即发生或延迟出现；在本研究中，我们分析了DBS术后延迟性脑出血的临床特征。
2008年1月至2016年11月期间，272例患者在DBS术后即刻及术后1天接受了脑部计算机断层扫描（CT）检查。其中，136例患者患有帕金森病，54例患有肌张力障碍，47例表现为特发性震颤，9例患有强迫症。
在接受448次DBS电极植入的272例患者中，13例出现术后脑出血。在研究期间，脑出血发生率为每根电极2.9%，每位患者4.77%。3例患者（1.1%）在DBS术后即刻出现脑出血，10例患者（3.7%）出现延迟性脑出血。其中，只有1例患者出现大的脑出血（30立方厘米）并伴有颅内压升高，随后接受了脑出血清除手术，恢复后无永久性神经功能缺损。其他12例患者出现小的脑出血（1 - 10立方厘米）。所有脑出血患者均未出现永久性残疾。
我们的研究表明，即使DBS术后即刻脑部CT正常，仍可能发生延迟性脑出血。由于脑出血可导致严重的神经后遗症，在对患者进行最佳管理时应考虑DBS术后延迟性脑出血的可能性。
