Rasiah Neilen P, Maheshwary Romir, Kwon Churl-Su, Bloomstein Joshua D, Girgis Fady
Department of Neurosurgery, Cumming School of Medicine, University of Calgary, Alberta, USA.
Department of Neurosurgery, University of California Davis School of Medicine, Sacramento, California, USA.
World Neurosurg. 2023 Mar;171:e8-e23. doi: 10.1016/j.wneu.2022.10.034. Epub 2022 Oct 13.
Deep brain stimulation is a common treatment for Parkinson's disease (PD). Despite strong efficacy in well-selected patients, complications can occur. Intraoperative micro-electrode recording (MER) can enhance efficacy by improving lead accuracy. However, there is controversy as to whether MER increases risk of hemorrhage.
To provide a comprehensive systematic review and meta-analysis reporting complication rates from deep brain stimulation in PD. We also interrogate the association between hemorrhage and MER.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were implemented while querying the Pubmed, Embase, and Cochrane databases. All included studies were randomized controlled trials and prospective case series with 5 or more patients. Primary outcomes included rates of overall revision, infection, lead malposition, surgical site and wound complications, hardware-related complications, and seizure. The secondary outcome was the relationship between number of MER tracks and hemorrhage rate.
262 articles with 21,261 patients were included in the analysis. Mean follow-up was 25.8 months (range 0-133). Complication rates were: revision 4.9%, infection 4.2%, lead malposition 3.3%, surgical site complications 2.8%, hemorrhage 2.4%, hardware-related complications 2.4%, and seizure 1.9%. While hemorrhage rate did not increase with single-track MER (odds ratio, 3.49; P = 0.29), there was a significant non-linear increase with each additional track.
Infection and lead malposition were the most common complications. Hemorrhage risk increases with more than one MER track. These results highlight the challenge of balancing surgical accuracy and perioperative risk.
脑深部电刺激是帕金森病（PD）的一种常见治疗方法。尽管在精心挑选的患者中疗效显著，但仍可能发生并发症。术中微电极记录（MER）可通过提高电极置入准确性来增强疗效。然而，MER是否会增加出血风险存在争议。
提供一项全面的系统评价和荟萃分析，报告帕金森病脑深部电刺激的并发症发生率。我们还探讨出血与MER之间的关联。
在查询PubMed、Embase和Cochrane数据库时遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。所有纳入研究均为随机对照试验和前瞻性病例系列，患者数为5例或更多。主要结局包括总体翻修率、感染率、电极位置不当率、手术部位和伤口并发症、硬件相关并发症以及癫痫发作率。次要结局是MER轨迹数量与出血率之间的关系。
分析纳入了262篇文章，共21261例患者。平均随访时间为25.8个月（范围0 - 133个月）。并发症发生率分别为：翻修4.9%，感染4.2%，电极位置不当3.3%，手术部位并发症2.8%，出血2.4%，硬件相关并发症2.4%，癫痫发作1.9%。虽然单轨迹MER不会增加出血率（优势比为3.49；P = 0.29），但每增加一条轨迹，出血率会有显著的非线性增加。
感染和电极位置不当是最常见的并发症。MER轨迹超过一条时出血风险增加。这些结果凸显了平衡手术准确性和围手术期风险的挑战。
