Minimising the rate of vascular complications in Deep Brain Stimulation surgery for the management of Parkinson’s disease: a single-centre 600-patient case series

ObjectivesDeep Brain Stimulation (DBS) is an effective, yet underused therapy for people living with Parkinson’s disease (PD) in whom tremor, motor fluctuations and/or dyskinesia are not satisfactorily controlled by oral medical therapy. Fear of vascular complications related to the operative proced...

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Bibliographic Details
Published in:BMJ neurology open 2024-10, Vol.6 (2), p.e000793
Main Authors: Cook, Raymond, Chennell Dutton, Nyssa, Silburn, Peter A, Meagher, Linton J, Fracchia, George, Anderson, Nathan, Cooper, Glen, Dinh, Hoang-Mai, Cook, Stuart J, Silberstein, Paul
Format: Article
Language:English
Subjects:
Deep brain stimulation
Dyskinesia
Electrodes
Local anesthesia
MOVEMENT DISORDERS
NEUROSURGERY
Original research
PARKINSON'S DISEASE
Patients
Software
STROKE
Surgery
Surgical outcomes
Tremor (Muscular contraction)
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Summary:ObjectivesDeep Brain Stimulation (DBS) is an effective, yet underused therapy for people living with Parkinson’s disease (PD) in whom tremor, motor fluctuations and/or dyskinesia are not satisfactorily controlled by oral medical therapy. Fear of vascular complications related to the operative procedure remains a strong reason for both the referrer and patient reluctance. We review the incidence of vascular complications in the first 600 patients with Parkinson’s disease treated at our centre by a single neurologist/neurosurgical team.MethodsSurgical data routinely collected for patients who underwent DBS implantation for the management of PD between the years 2001–2023 was retrospectively reviewed. Incidences of vascular complication were analysed in detail, examining causal factors.ResultsIncluding reimplantations, 600 consecutive DBS patients underwent implantation with 1222 DBS electrodes. Three patients (0.50%) experienced vascular complications.ConclusionThis vascular complication rate is at the low end of that reported in the literature. Risk mitigation strategies discussed include a consistent neurosurgical team, dual methodology target and trajectory planning, control of cerebrospinal fluid egress during the procedure, use of a specialised microelectrode recording (MER)/macrostimulation electrode without an introducing brain cannula and low number of MER passes. A reduced vascular complication rate may improve the acceptability of DBS therapy for both patients and referrers.
ISSN:2632-6140
2632-6140
DOI:10.1136/bmjno-2024-000793