Surgical, medical, and hardware adverse events in a series of 141 patients undergoing subthalamic deep brain stimulation for Parkinson disease

World Neurosurg. 2010 Apr;73(4):338-44. doi: 10.1016/j.wneu.2010.01.017.

Abstract

Background: Subthalamic deep brain stimulation has proved significant efficacy in the treatment of Parkinson disease. Adverse events, due to surgical and hardware-related complications, must be clearly addressed to properly balance the cost-effectiveness of the therapy. In addition, limited data exists about medical adverse events after surgery.

Methods: One hundred forty-one patients undergoing subthalamic deep brain stimulation for Parkinson disease from 1998 to 2007 were considered. Medical records, operative notes, clinical findings at follow-up and final outcome were accurately recorded to identify surgical- and hardware-related complications, infections and delayed adverse medical events.

Results: Five hundred twenty-two surgical procedures were performed, including electrodes positioning and impulse programmable generators implantation and substitutions. Mean follow-up of the patients was 4.6 years (9 months-10 years). Surgical complications were observed in 5.6% of patients, including two hemorrhages (1.4%) and three (2.1%) inabilities to complete the surgical procedure. Medical delayed adverse events affected 1.4% of patients, with a patient having a fatal aspiration pneumonia. Infections were seen in 5.6% of patients; removal of the hardware was necessary in 3.6%. Hardware-adverse events were observed in 7% of patients, generally requiring minor surgery. Direct surgical mortality was 0%; overall mortality was 0.7% and permanent surgical morbidity was 0.7%.

Conclusions: Deep brain stimulation can be regarded as a safe procedure. Mortality and permanent morbidity are very low, and surgical complications are relatively rare. Nevertheless, minor complications are not infrequent; hence the importance of continuous monitoring of the patients during the follow-up period.

MeSH terms

  • Aged
  • Contraindications
  • Deep Brain Stimulation / adverse effects*
  • Deep Brain Stimulation / instrumentation
  • Deep Brain Stimulation / methods
  • Electrodes / adverse effects
  • Electrodes / standards
  • Equipment Failure / statistics & numerical data
  • Female
  • Humans
  • Iatrogenic Disease / prevention & control
  • Intracranial Hemorrhages / etiology
  • Intracranial Hemorrhages / pathology
  • Intracranial Hemorrhages / prevention & control
  • Intraoperative Complications / etiology*
  • Intraoperative Complications / prevention & control
  • Male
  • Middle Aged
  • Mortality
  • Parkinson Disease / physiopathology
  • Parkinson Disease / therapy*
  • Pneumonia, Aspiration / etiology
  • Pneumonia, Aspiration / prevention & control
  • Postoperative Complications / etiology*
  • Postoperative Complications / pathology
  • Retrospective Studies
  • Risk Assessment / standards
  • Stereotaxic Techniques / adverse effects
  • Stereotaxic Techniques / instrumentation
  • Subthalamic Nucleus / anatomy & histology
  • Subthalamic Nucleus / physiology
  • Subthalamic Nucleus / surgery*
  • Surgical Wound Infection / etiology
  • Surgical Wound Infection / prevention & control