Surgical and hardware complications in subthalamic nucleus deep brain stimulation.

OBJECTIVE: To assess the surgical and hardware complications in 26 consecutive patients with movement disorders undergoing subthalamic deep brain stimulation (STN-DBS) in early practice at our institute. METHODS: The 26 patients in our institute were analyzed retrospectively. Group A included the first eight patients treated while we had no facility for microelectrode recording (MER), 16 intracranial procedures were performed and 8 batteries were implanted. Group B (with MER) included 18 patients, 35 intracranial procedures were performed and 18 batteries were implanted. RESULTS: The intracranial morbidity was 18.75% in group A and 5.71% in group B. The extracranial morbidity was 37.5% in group A and 16.67% in group B. There was no hardware-related infection in our study. The overall mortality rate was 7.69%, and deaths were not surgical related. CONCLUSIONS: The associated morbidity is significant in STN-DBS. The use of MER may improve the clinical outcome while decreasing the morbidity.

Microelectrode recording can be a good adjunct in magnetic resonance image-directed subthalamic nucleus deep brain stimulation for parkinsonism.

BACKGROUND: The contribution of MER to improving bilateral STN-DBS is debatable. To resolve the controversy and elucidate the role of MER in DBS, we compared the outcome of bilateral STN-DBS surgery with and without MER in parkinsonian patients. METHODS: From February 2002 to November 2002, the first 7 of 13 consecutive parkinsonian patients received STN-DBS without MER (group A), and the last 6 received STN-DBS with MER (group B). Pre- and postoperative assessments included scoring of UPDRS with video taping, and MR images. RESULTS: The mean Hoehn and Yahr stage was 3.6 in group A and 4.0 in group B. The mean follow-up was 7.4 months for group A and 5.3 months for group B. The mean coordinates of the tip of the permanent electrode relative to the mid-commissural point were x = 8.1 mm, y = 4.3 mm, and z = 5.9 mm for group A and x = 10.6 mm, y = 4.1 mm, and z = 6.9 mm for group B. When levodopa was withdrawn from group A for 12 hours at follow-up, the postoperative UPDRS total score improved by 27.6% (P = .01) and the motor score by 25.4% (P = .02); their LEDD decreased by 17.5% (P = .03). In group B, the postoperative UPDRS total score improved by 49.3% (P = .00002) and the motor score by 45.2% (P = .0004); LEDD decreased by 48.5% (P = .01). CONCLUSIONS: Although STN-DBS is a promising surgical modality for advanced parkinsonian patients, there is an inevitable learning curve associated with adopting this new procedure. Intraoperative MER is an effective way to ensure correct electrode placement in the STN. With the assistance of intraoperative MER, the outcome of STN-DBS can be improved significantly.