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Surgical strategies to minimize morbidity in deep brain stimulation in a series of 240 DBS procedures
EANS Academy. Matthies C. Sep 26, 2019; 276053; EP07012
Prof. Cordula Matthies
Prof. Cordula Matthies

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Abstract
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Objectve: 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. Recently, unexpectedly high incidences of surgical revisions and implant ex-plantations have been reported putting the whole method under discussion. Each surgical step needs close consideration in an intent to minimize any possible sequels.
Methods: 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, we implanted 473 electrodes (233 bilateral, 7 unilateral) after an average of 2 to 3 micro-electrodes for micro-recording and semi-macro-stimulation test applications. Early complications were one intra-operative epidural haematoma and single epileptic fits in 3 patients, no intra-cerebral haemorrhage (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 of each step of surgical planning and performance enables a significant reduction of morbidity in DBS. Certain biological phenomena such as idiopathic oedema occurred temporarily and need further investigation. Reliable interdisciplinary cooperation and careful patient evaluation early and long-term are milestones for long-term quality in DBS treatment.
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