Intracranial hemorrhage after removal of deep brain stimulation electrodes

Clinical article

James K. C. Liu Center for Neurological Restoration, Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland; and

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Hesham Soliman Center for Neurological Restoration, Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland; and

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Andre Machado Center for Neurological Restoration, Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland; and

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Milind Deogaonkar Center for Neurological Restoration, Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland; and

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Ali R. Rezai Department of Neurosurgery, The Ohio State University, Columbus, Ohio

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Object

Many previous studies have shown that placement of deep brain stimulation (DBS) electrodes carries a considerable risk of hemorrhage. To date, no studies have evaluated the incidence of intracranial hemorrhage after removal of DBS electrodes. The authors performed a retrospective chart review to identify the incidence and trends in hemorrhage after DBS electrode removal.

Methods

A retrospective chart review of all DBS electrodes removed at the Cleveland Clinic between October 2000 and May 2010 was performed. All patients underwent postoperative CT scanning. Each patient was evaluated for age, sex, side of placement, target, duration of lead placement, reason for removal, and medical comorbidities.

Results

A total of 78 lead removals were performed in the 10-year period (1300 leads were implanted during the same period). Of the 78 leads removed, 10 (12.8%) resulted in hemorrhages seen on postoperative CT scans. The hemorrhages were superficial cortical in 6 cases of lead removal (60%) and deep in 4 cases (40%). No statistically significant correlation to any of the factors evaluated was found. All hemorrhages were asymptomatic. The authors' retrospective study of 78 DBS lead removals revealed a high risk of intracranial hemorrhage (12.8% per lead). The risk of hemorrhage during removal is significantly greater than the risk of hemorrhage during implantation (2.0% per lead at the authors' center during the same period). There were more superficial hemorrhages, and all hemorrhages were asymptomatic.

Conclusions

Removal of DBS leads carries a significantly higher risk of postoperative hemorrhages that are seen on images but are not clinically symptomatic.

Abbreviations used in this paper:

DBS = deep brain stimulation; GPi = globus pallidus internus; STN = subthalamic nucleus.
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