Surgical Complications

Surgical complications are those that occur within 30 days of surgery. These complications are typical of those seen with other intracranial stereotactic procedures and generally occur in less than 5% of the patients. These complications include hemorrhage, ischemic lesions, seizures, infections, and misplaced leads. Several studies have focused on the examination of surgical complications related to DBS. Beric et al. (46) reported 86 patients who received 149 DBS implants in the VIM nucleus of the thalamus, GPi or STN for PD, essential tremor, multiple sclerosis, or dystonia. In this cohort, 2.3% (n = 2) of the patients had a hemorrhage, 2.3% (n = 2) had seizures, 1.2% (n = 1) had a delayed hematoma two months after surgery, and 4.7% (n = 4) had postsurgical confusion. Umemura et al. (47) reported surgical complications in 109 patients receiving DBS of the VIM nucleus of the thalamus, GPi, STN, or anterior nucleus of the thalamus for PD, essential tremor, epilepsy, or dystonia. They reported two deaths, one from a pulmonary embolus and the other from pneumonia. Other surgical complications included pulmonary embolism (1.8%; n = 2), subcortical hemorrhage (1.8%; n = 2), chronic subdural hematoma (1.8%; n = 2), venous infarction (0.9%; n = 1), seizure (0.9%; n = 1), infection (3.7%; n=4), cerebral spinal fluid leak (0.9%; n = 1), and skin erosion on the scalp (0.9%; n = 1). In addition to these complications, several patients had postoperative sterile seromas at the IPG and three had transient confusion. Finally, Lyons et al. (48) reported complications in 81 PD patients after 160 STN DBS procedures. In this series, 4.9% (n =4) of the procedures were aborted due to adverse events in the operating room in three and inability to get a response in one. There were no deaths or permanent neurological deficits related to surgery. Surgical complications included hemorrhage in 1.2% (n = 1) of patients, seizure in 1.2% (n = 1), system infection in 2.5% (n = 2), IPG infection in 3.7% (n = 3), and misplaced leads in 12.5% (n = 10).

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