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深部脑刺激治疗帕金森病的并发症:单中心 517 例连续病例经验。

Complications of deep brain stimulation in Parkinson's disease: a single-center experience of 517 consecutive cases.

机构信息

Neurosurgical Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Lombardia, Italy.

Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy.

出版信息

Acta Neurochir (Wien). 2023 Nov;165(11):3385-3396. doi: 10.1007/s00701-023-05799-w. Epub 2023 Sep 29.


DOI:10.1007/s00701-023-05799-w
PMID:37773459
Abstract

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.

摘要

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。

相似文献

[1]
Complications of deep brain stimulation in Parkinson's disease: a single-center experience of 517 consecutive cases.

Acta Neurochir (Wien). 2023-11

[2]
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Acta Neurochir (Wien). 2007

[3]
Surgical and Hardware Complications of Deep Brain Stimulation-A Single Surgeon Experience of 519 Cases Over 20 Years.

Neuromodulation. 2022-8

[4]
Hemorrhagic complications seen on immediate intraprocedural stereotactic computed tomography imaging during deep brain stimulation implantation.

J Neurol Sci. 2019-3-14

[5]
Clinical analysis and treatment of symptomatic intracranial hemorrhage after deep brain stimulation surgery.

Br J Neurosurg. 2017-4

[6]
Systematic review of hardware-related complications of Deep Brain Stimulation: Do new indications pose an increased risk?

Brain Stimul. 2017-7-13

[7]
Risks of common complications in deep brain stimulation surgery: management and avoidance.

J Neurosurg. 2013-11-15

[8]
Peri-lead edema after deep brain stimulation surgery for Parkinson's disease: a prospective magnetic resonance imaging study.

Eur J Neurol. 2018-11-18

[9]
Clinical outcomes using ClearPoint interventional MRI for deep brain stimulation lead placement in Parkinson's disease.

J Neurosurg. 2016-4

[10]
Surgical-Related and Hardware-Related Adverse Effects of Deep Brain Stimulation: A Retrospective Single-Center Analysis.

Turk Neurosurg. 2022

引用本文的文献

[1]
Optimizing Multivariable Logistic Regression for Identifying Perioperative Risk Factors for Deep Brain Stimulator Explantation: A Pilot Study.

Clin Pract. 2025-7-17

[2]
Seizure incidence after deep brain stimulation: a meta-analysis of risk factors and target-specific outcomes in non-epileptic disorders.

Neurosurg Rev. 2025-7-14

[3]
Intraputaminal Delivery of Adeno-Associated Virus Serotype 2-Glial Cell Line-Derived Neurotrophic Factor in Mild or Moderate Parkinson's Disease.

Mov Disord. 2025-5-20

[4]
Risk of Cerebrovascular Events in Deep Brain Stimulation for Parkinson's Disease Focused on STN and GPi: Systematic Review and Meta-Analysis.

Brain Sci. 2025-4-18

[5]
Effectiveness of a home-based computerized cognitive training in Parkinson's disease: a pilot randomized cross-over study.

Front Psychol. 2025-1-9

[6]
Risk factors for delirium occurring after deep brain stimulation surgery in patients with Parkinson's disease.

Acta Neurochir (Wien). 2024-11-23

[7]
Minimising the rate of vascular complications in Deep Brain Stimulation surgery for the management of Parkinson's disease: a single-centre 600-patient case series.

BMJ Neurol Open. 2024-10-26

[8]
Longitudinal Neuropsychological Assessment of Symptomatic Edema after Subthalamic Nucleus Deep Brain Stimulation Surgery: A Case Series Study.

Neurol Int. 2023-12-28

本文引用的文献

[1]
Hardware-Related Skin Erosion in Deep Brain Stimulation for Parkinson's Disease: How Far Can We Go? An Illustrative Case Report.

Brain Sci. 2022-12-15

[2]
Implantable Pulse Generators for Deep Brain Stimulation: Challenges, Complications, and Strategies for Practicality and Longevity.

Front Hum Neurosci. 2021-8-26

[3]
Deep Brain Stimulation-Related Surgical Site Infections: A Systematic Review and Meta-Analysis.

Neuromodulation. 2021-2

[4]
How to avoid pneumocephalus in deep brain stimulation surgery? Analysis of potential risk factors in a series of 100 consecutive patients.

Acta Neurochir (Wien). 2021-1

[5]
Incidence and risk factors for seizures associated with deep brain stimulation surgery.

J Neurosurg. 2020-8-7

[6]
Does post-operative symptomatic lead edema associated with subthalamic DBS implantation impact long-term clinical outcomes?

J Neurol Sci. 2020-3-15

[7]
Current and future directions of deep brain stimulation for neurological and psychiatric disorders.

J Neurosurg. 2019-8-1

[8]
Hemorrhagic complications seen on immediate intraprocedural stereotactic computed tomography imaging during deep brain stimulation implantation.

J Neurol Sci. 2019-3-14

[9]
Glial responses to implanted electrodes in the brain.

Nat Biomed Eng. 2017-11

[10]
Venous Infarct after Sacrifice of Single Cortical Vein during Deep-Brain Stimulation Surgery.

Asian J Neurosurg. 2018

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