Deep brain stimulation for movement disorders: morbidity and mortality in 109 patients

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Object. Deep brain stimulation (DBS) has been advocated as a more highly effective and less morbidity-producing alternative to ablative stereotactic surgery in the treatment of medically intractable movement disorders. Nevertheless, the exact incidence of morbidity and mortality associated with the procedure is not well known. In this study the authors reviewed the surgical morbidity and mortality rates in a large series of DBS operations.

Methods. The authors retrospectively analyzed surgical complications in their consecutive series of 179 DBS implantations in 109 patients performed by a single surgical team at one center between July 1998 and April 2002. The mean follow-up period was 20 months.

There were 16 serious adverse events related to surgery in 14 patients (12.8%). There were two perioperative deaths (1.8%), one caused by pulmonary embolism and the second due to aspiration pneumonia. The other adverse events were two pulmonary embolisms, two subcortical hemorrhages, two chronic subdural hematomas, one venous infarction, one seizure, four infections, one cerebrospinal fluid leak, and one skin erosion. The incidence of permanent sequelae was 4.6% (five of 109 patients). The incidence of device-related complications, such as infection or skin erosion, was also 4.6% (five of 109 patients).

Conclusions. There is a significant incidence of adverse events associated with the DBS procedure. Nevertheless, DBS is clinically effective in well-selected patients and should be seriously considered as a treatment option for patients with medically refractory movement disorders.

Article Information

Address reprint requests to: Gordon H. Baltuch, M.D., Ph.D., Department of Neurosurgery, Penn Neurological Institute at Pennsylvania Hospital, 330 South 9th Street, Philadelphia, Pennsylvania 19107. email: gordon.baltuch@uphs.upenn.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    A computerized tomography scan obtained 6 hours after surgery revealing subcortical hemorrhage at the site of DBS implantation. The computerized tomography scan obtained immediately postoperatively did not demonstrate the hemorrhage.

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    Coronal T2-weighted MR image demonstrating a broad, high-intensity lesion that is consistent with venous infarction at the site of DBS implantation.

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