Objective: DBS may improve quality of life in advanced movement disorders, but bears a significant risk of early and late complications such as hemorrhage, infection and material extrusion. Each surgical step needs close consideration in an intent to minimize any possible sequels.

Background: Recently, unexpectedly high incidences of surgical revisions and implant ex-plantations have been reported put the whole method under discussion (Rolston et al. 2016).

Method: In a prospectively collected series of 240 DBS procedures (152 for Parkinson’s disease, 49 for dystonia, 34 for essential tremor, 5 for rare indications) we applied special techniques in skin approach, burr hole closure, electrode fixation, placing of extensions, trajectory and target planning, micro-electrode selection and modification aiming for a minimal incidence of complications early (post-surgical in-clinic phase) and long-term with a (minimum follow-up of one year).

Results: In 240 consecutive interventions, 473 electrodes (233 bilateral, 7 unilateral) were implanted after an average of 2 to 3 micro-electrodes for micro-recording and semi-macro-stimulation test applications. Early complications included one intra-operative epidural hematoma, ingle epileptic fits in 3 patients, no intracerebral hemorrhage (0.0%), no infection (0.0%). An idiopathic delayed onset edema was documented in 9 patients, temporary confusion in 10 PD patients. In 10 patients (0.4%), lead revision was performed because of insufficient stimulation effect (8 patients) or upward lead dislocation (2 patients). Long-term, two patients suffered skin lesions from repeated falls and needed material ex-plantation and re-implantation. One late electrode dislocation after 5 years after repeated falls which was treated by successful stereotactic re-positioning.

Conclusion: Careful consideration and optimization of each step of surgical planning and performance enable a significant reduction of morbidity in DBS. Certain biological phenomena such as idiopathic edema need further observation and investigation. Reliable interdisciplinary cooperation and careful patient evaluation early and long-term are milestones for long-term quality in DBS treatment.

References: Rolston JD, Englot DJ, Starr PA, Larson PS: An unexpectedly high rate of revisions and removals in DBS surgery: Analysis of multipe databases. Parkinsonism and related disorders 2016, 1-6.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/strategies-to-minimize-complications-in-deep-brain-stimulation-in-a-series-of-240-dbs-procedures/