Incidence of symptomatic hemorrhage after stereotactic electrode placement

Restricted access

Object

Intracranial hemorrhage (ICH) is the most significant complication associated with the placement of stereotactic intracerebral electrodes. Previous reports have suggested that hypertension and the use of microelectrode recording (MER) are risk factors for cerebral hemorrhage. The authors evaluated the incidence of symptomatic ICH in a large cohort of patients with various diseases treated with stereotactic electrode placement. They examined the effect of comorbidities on the risk of ICH and independently assessed the risks associated with age, sex, use of MER, diagnosis, target location, hypertension, and previous use of anticoagulant medications. The authors also evaluated the effect of hemorrhage on length of hospital stay and discharge disposition.

Methods

Between 1991 and 2005, 567 electrodes were placed by two neurosurgeons during 337 procedures in 259 patients. Deep brain stimulation (DBS) was performed in 167 procedures, radiofrequency lesioning (RFL) of subcortical structures in 74, and depth electrodes were used in 96 procedures in patients with epilepsy. Electrodes were grouped according to target, patient diagnosis, use of MER, patient history of hypertension, and patient prior use of anticoagulant medication (stopped 10 days before surgery). The Charlson Comorbidity Index (CCI) was used to evaluate the effect of comorbidities. The CCI score, patient age, length of hospital stay, and discharge status were continuous variables. Symptomatic hemorrhages were grouped as transient or leading to permanent neurological deficits.

Results

The risk of hemorrhage leading to permanent neurological deficits in this study was 0.7%, and the risk of symptomatic hemorrhage was 1.2%. A patient history of hypertension was the most significant factor associated with hemorrhage (p = 0.007). Older age, male sex, and a diagnosis of Parkinson disease (PD) were also significantly associated with hemorrhage (p = 0.01, 0.04, 0.007, respectively). High CCI scores, specific target locations, and prior use of anticoagulant therapy were not associated with an increased risk of hemorrhage. The use of MER was not found to be correlated with an increased hemorrhage rate (p = 0.34); however, the number of hemorrhages in the patients who underwent DBS was insufficient to draw definitive conclusions. The mean length of stay for the DBS, RFL, and depth electrode patient groups was 2.9, 2.6, and 11.0 days, respectively. For patients who received DBS and RFL, the mean duration of hospitalization in cases of symptomatic hemorrhage was 8.2 days compared with 2.7 days in those without hemorrhaging (p < 0.0001). Three of the seven patients with symptomatic hemorrhages were discharged home.

Conclusions

The placement of stereotactic electrodes is generally safe, with a symptomatic hemorrhage rate of 1.2%, and a 0.7% rate of permanent neurological deficit. Consistent with prior reports, this study confirms that hypertension is a significant risk factor for hemorrhage. Age, male sex, and diagnosis of PD were also significant risk factors. Patients with symptomatic hemorrhage had longer hospital stays and were less likely to be discharged home.

Abbreviations used in this paper:CCI = Charlson Comorbidity Index; CT = computed tomography; DBS = deep brain stimulation; ICH = intracranial hemorrhage; MER = microelectrode recording; MR = magnetic resonance; PD = Parkinson disease; RFL = radiofrequency lesioning; STN = subthalamic nucleus.

Article Information

Address correspondence to: W. Jeffrey Elias, M.D., Department of Neurological Surgery, University of Virginia, Box 800212, Charlottesville, Virginia 22908. email: wje4r@virginia.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Axial CT slices through the maximal extent of hemorrhage obtained in Patients 4 (A), 5 (B), 6 (C), and 7 (D) (see Table 3). Images from Patients 1, 2, and 3 were not available from the University of Virginia Department of Radiology archives.

References

  • 1

    Beric AKelly PJRezai ASterio DMogilner AZonenshayn M: Complications of deep brain stimulation surgery. Stereotact Funct Neurosurg 77:73782001

  • 2

    Binder DKRau GStarr PA: Hemorrhagic complications of microelectrode-guided deep brain stimulation. Stereotact Funct Neurosurg 80:28312003

  • 3

    Binder DKRau GMStarr PA: Risk factors for hemorrhage during microelectrode-guided deep brain stimulator implantation for movement disorders. Neurosurgery 56:7227322005

  • 4

    Birim OMaat APKappetein APvan Meerbeeck JPDamhuis RABogers AJ: Validation of the Charlson comorbidity index in patients with operated primary non-small cell lung cancer. Eur J Cardiothorac Surg 23:30342003

  • 5

    Charlson MEPompei PAles KLMacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:3733831987

  • 6

    Favre JTaha JMBurchiel KJ: An analysis of the respective risks of hematoma formation in 361 consecutive morphological and functional stereotactic procedures. Neurosurgery 50:48572002

  • 7

    Froehner M: Re: Charlson comorbidity index as a predictor of outcome after surgery for renal cell carcinoma with renal vein, vena cava or right atrium extension. J Urol 170:19542003

  • 8

    Froehner MKoch RLitz RHeller AOehlschlaeger SWirth MP: Comparison of the American Society of Anesthesiologists Physical Status classification with the Charlson score as predictors of survival after radical prostatectomy. Urology 62:6987012003

  • 9

    Froehner MKoch RLitz ROehlschlaeger SWirth MP: Which conditions contributing to the Charlson score predict survival after radical prostatectomy?. J Urol 171:6976992004

  • 10

    Gorgulho ADe Salles AAFrighetto LBehnke E: Incidence of hemorrhage associated with electrophysiological studies performed using macroelectrodes and microelectrodes in functional neurosurgery. J Neurosurg 105:8888962005

  • 11

    Hariz MI: Safety and risk of microelectrode recording in surgery for movement disorders. Stereotact Funct Neurosurg 78:1461572002

  • 12

    Honey CRBerk CPalur RSSchulzer M: Microelectrode recording for pallidotomy: mandatory, beneficial or dangerous?. Stereotact Funct Neurosurg 77:981002001

  • 13

    Limousin PKrack PPollak PBenazzouz AArdouin CHoffmann D: Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 339:110511111998

  • 14

    Lubke TMönig SPSchneider PMHölscher AHBollschweiler E: [Does Charlson-comorbidity index correlate with short-term outcome in patients with gastric cancer?]. Zentralbl Chir 128:9709762003. (Ger)

  • 15

    Lyons KEWilkinson SBOverman JPahwa R: Surgical and hardware complications of subthalamic stimulation: a series of 160 procedures. Neurology 63:6126162004

  • 16

    Ouellette JRSmall DGTermuhlen PM: Evaluation of Charlson-Age Comorbidity Index as predictor of morbidity and mortality in patients with colorectal carcinoma. J Gastrointest Surg 8:106110672004

  • 17

    Paleri VWight RG: Applicability of the adult comorbidity evaluation—27 and the Charlson indexes to assess comorbidity by notes extraction in a cohort of United Kingdom patients with head and neck cancer: a retrospective study. J Laryngol Otol 116:2002052002

  • 18

    Terao TTakahashi HYokochi FTaniguchi MOkiyama RHamada I: Hemorrhagic complication of stereotactic surgery in patients with movement disorders. J Neurosurg 98:124112462003

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 130 130 19
Full Text Views 152 152 5
PDF Downloads 72 72 5
EPUB Downloads 0 0 0

PubMed

Google Scholar