Risks of intracranial hemorrhage in patients with Parkinson's disease receiving deep brain stimulation and ablation.

OBJECTIVES This study analyzed risk factors for hemorrhage in a large series of deep brain stimulation (DBS) and ablation procedures in patients with advanced Parkinson's disease (PD). METHODS Six hundred and forty four subjects with advanced PD treated with DBS or ablation procedures between March 1999 and December 2007 were enrolled in the study. Procedures were performed by the same surgeon, and included DBS in 126 patients, ablation in 507 patients and DBS after prior unilateral ablation procedures in 11 patients. Of 796 target procedures, 207 were DBS including 202 subthalamic nucleus (STN) targets, 3 ventralis intermedius nucleus (Vim) targets and 2 globus pallidus internus (GPi) targets, and the others were 589 ablation procedures including 474 GPi targets and 115 Vim targets. Postoperative CT or MRI was performed in all patients within 24 h of lead implantation or ablation treatment. Statistical correlation analysis of risk factors for intracranial hemorrhage (ICH) was performed by stepwise logistic regression. Explanatory variables were patient age, sex, blood pressure, anatomical targets, the number of microelectrode recording (MER) penetrations and surgical modality. RESULTS Postoperative symptomatic ICH occurred in 10 cases (8 pallidotomy and 2 thalamotomy) and asymptomatic ICH in 14 cases (9 pallidotomy, 4 thalamotomy and 1 DBS). Hypertension and surgical modality were significant factors contributing to hemorrhage (both P < 0.05). The likelihood of hemorrhage in hypertensive patients was 2.5 times that in normotensive patients. The risk of hemorrhage during ablation was 5.4 times that in DBS. The number of MER trajectories did not significantly correlate with ICH occurrence (P = 0.07). No statistically significant difference was found in age, sex and anatomical targets. CONCLUSION This study demonstrated that hypertension is a risk factor for ICH in PD patients. DBS is generally a safe surgical modality as compared with ablation. Increasing microelectrode trajectories seemed to increase the risk of ICH, but no statistically significant difference was found (P = 0.07).

[1]  J. Dostrovsky,et al.  Effect of GPi pallidotomy on motor function in Parkinson's disease , 1995, The Lancet.

[2]  C. Honey,et al.  A metaanalysis comparing the results of pallidotomy performed using microelectrode recording or macroelectrode stimulation. , 2002, Journal of neurosurgery.

[3]  Marwan I. Hariz,et al.  Safety and Risk of Microelectrode Recording in Surgery for Movement Disorders , 2003, Stereotactic and Functional Neurosurgery.

[4]  Marwan I. Hariz,et al.  Are Complications Less Common in Deep Brain Stimulation than in Ablative Procedures for Movement Disorders? , 2004, Stereotactic and Functional Neurosurgery.

[5]  G. Deuschl,et al.  A randomized trial of deep-brain stimulation for Parkinson's disease. , 2006, The New England journal of medicine.

[6]  A. Benabid,et al.  Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. , 2003, The New England journal of medicine.

[7]  John T. Gale,et al.  RISK FACTORS FOR HEMORRHAGE DURING MICROELECTRODE‐GUIDED DEEP BRAIN STIMULATION AND THE INTRODUCTION OF AN IMPROVED MICROELECTRODE DESIGN , 2009, Neurosurgery.

[8]  M. Hariz,et al.  Leksell's posteroventral pallidotomy in the treatment of Parkinson's disease. , 1992, Journal of neurosurgery.

[9]  E. Behnke,et al.  Incidence of hemorrhage associated with electrophysiological studies performed using macroelectrodes and microelectrodes in functional neurosurgery. , 2005, Journal of neurosurgery.

[10]  M. Hariz,et al.  Do Microelectrode Techniques Increase Accuracy or Decrease Risks in Pallidotomy and Deep Brain Stimulation? , 2000, Stereotactic and Functional Neurosurgery.

[11]  J. Voges,et al.  Deep-brain stimulation: long-term analysis of complications caused by hardware and surgery—experiences from a single centre , 2006, Journal of Neurology, Neurosurgery & Psychiatry.

[12]  Devin K. Binder,et al.  Hemorrhagic Complications of Microelectrode-Guided Deep Brain Stimulation , 2004, Stereotactic and Functional Neurosurgery.

[13]  Microelectrode Recording for Pallidotomy: Mandatory, Beneficial or Dangerous? , 2002, Stereotactic and Functional Neurosurgery.

[14]  I. Hamada,et al.  Hemorrhagic complication of stereotactic surgery in patients with movement disorders. , 2003, Journal of neurosurgery.

[15]  Nader Pouratian,et al.  Incidence of symptomatic hemorrhage after stereotactic electrode placement. , 2007, Journal of neurosurgery.

[16]  E. Eskandar,et al.  Stereotactic pallidotomy performed without using microelectrode guidance in patients with Parkinson's disease: surgical technique and 2-year results. , 2000, Journal of neurosurgery.

[17]  Gordon H Baltuch,et al.  Deep brain stimulation for movement disorders: morbidity and mortality in 109 patients. , 2003, Journal of neurosurgery.

[18]  A. Benabid,et al.  Improvement in Parkinson disease by subthalamic nucleus stimulation based on electrode placement: effects of reimplantation. , 2008, Archives of neurology.

[19]  P. Starr,et al.  Implantation of deep brain stimulators into the subthalamic nucleus: technical approach and magnetic resonance imaging-verified lead locations. , 2002, Journal of neurosurgery.

[20]  Alexandre Mendes,et al.  Treatment results: Parkinson's disease , 2002, Movement disorders : official journal of the Movement Disorder Society.

[21]  J. Jankovic,et al.  Five-year follow-up of unilateral posteroventral pallidotomy in Parkinson's disease. , 2009, Surgical neurology.

[22]  Li Qinchuan,et al.  Analysis of Complications of Radiofrequency Pallidotomy , 2003, Neurosurgery.

[23]  Rajesh Pahwa,et al.  Surgical and hardware complications of subthalamic stimulation , 2004, Neurology.

[24]  Philip A Starr,et al.  Risk Factors for Hemorrhage during Microelectrode-guided Deep Brain Stimulator Implantation for Movement Disorders , 2005, Neurosurgery.

[25]  M. Álvarez-Vega,et al.  Complications in subthalamic nucleus stimulation surgery for treatment of Parkinson’s disease. Review of 272 procedures , 2007, Acta Neurochirurgica.

[26]  N. Kumar,et al.  Bilateral Deep Brain Stimulation vs Best Medical Therapy for Patients With Advanced Parkinson Disease: A Randomized Controlled Trial , 2009 .