Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
Department of Neurology, Clinic Lahr, Lahr, Germany.
Oper Neurosurg. 2022 Aug 1;23(2):e108-e113. doi: 10.1227/ons.0000000000000275. Epub 2022 May 26.
Deep brain stimulation (DBS) surgery has advanced tremendously, for both clinical applications and technology. Although DBS surgery is an overall safe procedure, rare side effects, in particular, hemorrhage, may result in devastating consequences. Although there are certain advantages with transventricular trajectories, it has been reasoned that avoidance of such trajectories would likely reduce hemorrhage.
To investigate the possible impact of a transventricular trajectory as compared with a transcerebral approach on the occurrence of symptomatic and asymptomatic hemorrhage after DBS electrode placement.
Retrospective evaluation of 624 DBS surgeries in 582 patients, who underwent DBS surgery for movement disorders, chronic pain, or psychiatric disorders. A stereotactic guiding cannula was routinely used for DBS electrode insertion. All patients had postoperative computed tomography scans within 24 hours after surgery.
Transventricular transgression was identified in 404/624 DBS surgeries. The frequency of hemorrhage was slightly higher in transventricular than in transcerebral DBS surgeries (15/404, 3.7% vs 6/220, 2.7%). While 7/15 patients in the transventricular DBS surgery group had a hemorrhage located in the ventricle, 6 had an intracerebral hemorrhage along the electrode trajectory unrelated to transgression of the ventricle and 2 had a subdural hematoma. Among the 7 patients with a hemorrhage located in the ventricle, only one became symptomatic. Overall, a total of 7/404 patients in the transventricular DBS surgery group had a symptomatic hemorrhage, whereas the hemorrhage remained asymptomatic in all 6/220 patients in the transcerebral DBS surgery group.
Transventricular approaches in DBS surgery can be performed safely, in general, when special precautions such as using a guiding cannula are routinely applied.
脑深部电刺激（DBS）手术在临床应用和技术方面都取得了巨大进展。尽管 DBS 手术是一种总体安全的手术，但仍存在罕见的副作用，特别是出血，可能导致灾难性后果。尽管经脑室轨迹具有某些优势，但人们认为避免这种轨迹可能会减少出血。
研究 DBS 电极植入后，与经颅入路相比，经脑室入路对症状性和无症状性出血的发生的可能影响。
对 582 例接受 DBS 手术治疗运动障碍、慢性疼痛或精神障碍的患者的 624 例 DBS 手术进行回顾性评估。DBS 电极插入常规使用立体定向引导套管。所有患者术后 24 小时内行 CT 扫描。
404/624 例 DBS 手术中存在经脑室穿破。经脑室与经颅 DBS 手术的出血发生率略高（15/404，3.7% vs 6/220，2.7%）。经脑室 DBS 手术组 7 例患者的出血位于脑室内，6 例为沿电极轨迹的颅内出血，与脑室穿破无关，2 例为硬膜下血肿。在脑室出血的 7 例患者中，仅有 1 例出现症状。总体而言，经脑室 DBS 手术组的 7/404 例患者发生症状性出血，而经颅 DBS 手术组的 6/220 例患者的出血均无症状。
一般来说，当常规应用特殊预防措施（如使用引导套管）时，经脑室入路在 DBS 手术中是安全的。
