Department of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, Maharastra, India.
Department of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, Maharastra, India.
Neuromodulation. 2022 Aug;25(6):895-903. doi: 10.1111/ner.13360. Epub 2022 Feb 15.
Deep brain stimulation (DBS) surgery has its own set of risks and complications. This study from a single center and a single surgeon analyzes various risk factors for complications and tries to establish if there is a learning curve effect in minimizing the complications.
A retrospective analysis of 519 patients (1024 leads) who underwent DBS surgery and 232 patients who underwent implantable pulse generator replacement (IPG), by a single surgeon, between the years 1999 and 2019 was performed. Perioperative and hardware related complications were evaluated.
The follow-up period ranged from six months to 20 years. Surgery-related complications occurred in 46 (8.9%) cases which included confusion in 31 (5.98%), intracerebral hemorrhage in 7 (1.3%), vasovagal attack in 3 (0.58%), respiratory distress in 2 (0.38%), postoperative aggressiveness in 1 (0.19%), and blepharospasm in 2 (0.38%) patients. Complications related to the DBS hardware were found in 35 cases, including erosion and infection in 22 (2.95%), inaccurate lead placement or migration in 6 (0.6%) lead fracture/extension wire failure in 2 (0.26%), IPG malfunction in 2 (0.26%), and hardware discomfort in 3 (0.4%) cases. In three patients, one lead was repositioned. In cases of infection, 87% of patients had either partial or complete removal of hardware. There was no mortality. The complications were analyzed for every 100 DBS procedures. There was a significant drop in the percentage of complications in from 23% in the first 100 cases to 7% in the last 100 cases (p < 0.0001).
Confusion remains the most frequent operative and perioperative complication. Erosion and infection of the surgical site represents the most frequent hardware complication. DBS surgery is safe and the complication rates are acceptably low. The complication rate also decreases with cumulative years of experience, demonstrating a learning curve effect.
脑深部电刺激（DBS）手术有其自身的一系列风险和并发症。本研究来自于单中心和单外科医生，分析了各种并发症的风险因素，并试图确定是否存在最小化并发症的学习曲线效应。
对 1999 年至 2019 年间由一位外科医生进行的 519 例（1024 个导联）DBS 手术和 232 例植入式脉冲发生器更换（IPG）患者进行了回顾性分析。评估围手术期和硬件相关并发症。
随访时间为 6 个月至 20 年。手术相关并发症发生在 46 例（8.9%）患者中，包括 31 例（5.98%）意识混乱、7 例（1.3%）颅内出血、3 例（0.58%）血管迷走神经性发作、2 例（0.38%）呼吸窘迫、1 例（0.19%）术后攻击性、2 例（0.38%）眼睑痉挛。发现 35 例与 DBS 硬件相关的并发症，包括 22 例（2.95%）侵蚀和感染、6 例（0.6%）不准确的导联放置或迁移、2 例（0.26%）导联断裂/延长线故障、2 例（0.26%）IPG 故障和 3 例（0.4%）硬件不适。在 3 例患者中，一根导联重新定位。在感染病例中，87%的患者要么部分要么完全去除了硬件。没有死亡病例。对每 100 例 DBS 手术进行并发症分析。在前 100 例中，并发症的百分比从 23%显著下降到最后 100 例中的 7%（p<0.0001）。
意识混乱仍然是最常见的手术和围手术期并发症。手术部位的侵蚀和感染是最常见的硬件并发症。DBS 手术是安全的，并发症发生率较低。并发症发生率也随着累计工作年限的增加而降低，表现出学习曲线效应。
