Neurosurgical Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Lombardia, Italy.
Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy.
Acta Neurochir (Wien). 2023 Nov;165(11):3385-3396. doi: 10.1007/s00701-023-05799-w. Epub 2023 Sep 29.
BACKGROUND: The number of deep brain stimulation (DBS) procedures is rapidly rising as well as the novel indications. Reporting adverse events related to surgery and to the hardware used is essential to define the risk-to-benefit ratio and develop novel strategies to improve it. OBJECTIVE: To analyze DBS complications (both procedure-related and hardware-related) and further assess potential predictive factors. METHODS: Five hundred seventeen cases of DBS for Parkinson's disease were performed between 2006 and 2021 in a single center (mean follow-up: 4.68 ± 2.86 years). Spearman's Rho coefficient was calculated to search for a correlation between the occurrence of intracerebral hemorrhage (ICH) and the number of recording tracks. Multiple logistic regression analyzed the probability of developing seizures and ICH given potential risk factors. Kaplan-Meier curves were performed to analyze the cumulative proportions of hardware-related complications. RESULTS: Mortality rate was 0.2%, while permanent morbidity 0.6%. 2.5% of cases suffered from ICH which were not influenced by the number of tracks used for recordings. 3.3% reported seizures that were significantly affected by perielectrode brain edema and age. The rate of perielectrode brain edema was significantly higher for Medtronic's leads compared to Boston Scientific's (Χ(1)= 5.927, P= 0.015). 12.2% of implants reported Hardware-related complications, the most common of which were wound revisions (7.2%). Internal pulse generator models with smaller profiles displayed more favorable hardware-related complication survival curves compared to larger designs (X(1)= 8.139, P= 0.004). CONCLUSION: Overall DBS has to be considered a safe procedure, but future research is needed to decrease the rate of hardware-related complications which may be related to both the surgical technique and to the specific hardware's design. The increased incidence of perielectrode brain edema associated with certain lead models may likewise deserve future investigation.
背景:随着新适应证的出现,深部脑刺激(DBS)手术数量迅速增加。报告与手术和使用的硬件相关的不良事件对于确定风险效益比以及制定提高风险效益比的新策略至关重要。
目的:分析 DBS 并发症(包括手术相关和硬件相关),并进一步评估潜在的预测因素。
方法:在一个中心进行了 517 例帕金森病的 DBS 手术(2006 年至 2021 年),平均随访 4.68±2.86 年。计算 Spearman's Rho 系数以搜索颅内出血(ICH)的发生与记录轨迹数量之间的相关性。多元逻辑回归分析了潜在危险因素下发生癫痫和 ICH 的概率。Kaplan-Meier 曲线用于分析硬件相关并发症的累积比例。
结果:死亡率为 0.2%,永久性发病率为 0.6%。2.5%的病例发生 ICH,ICH 的发生与使用的记录轨迹数量无关。3.3%的病例出现癫痫,癫痫的发生与电极周围脑水肿和年龄显著相关。与 Boston Scientific 相比,Medtronic 导联的电极周围脑水肿发生率明显更高(Χ(1)=5.927,P=0.015)。12.2%的植入物报告了与硬件相关的并发症,其中最常见的是伤口修正(7.2%)。与较大设计相比,具有较小轮廓的内部脉冲发生器模型显示出更有利的硬件相关并发症生存曲线(X(1)=8.139,P=0.004)。
结论:总体而言,DBS 被认为是一种安全的手术,但需要进一步研究以降低与硬件相关的并发症发生率,这些并发症可能与手术技术和特定硬件的设计有关。与某些导联模型相关的电极周围脑水肿发生率增加也值得进一步研究。
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