-
[show abstract]
[hide abstract]
ABSTRACT: Deep brain stimulation is the most frequently performed neurosurgical procedure for movement disorders. This procedure is well tolerated, but not free of complications. Analysis of hardware complications based on patient diagnosis and lead location could prove valuable in recognizing potential pitfalls and patients at higher risk.
This review analyzes the most common surgery-related complications that may occur based on diagnosis and lead location. Patients were categorized based on diagnosis - Parkinson's disease (PD), dystonia, and essential tremor (ET) - as well as by lead location - subthalamic nucleus (STN), globus pallidus interna (GPi), and ventral intermediate nucleus of the thalamus (Vim). It is a retrospective review of 326 patients undergoing 949 procedures over a 10-year period by one surgeon. Fisher's exact test and χ(2) test were employed and multivariate logistic regression analysis was performed to identify the significant variables of correlation.
Overall lead revision was observed at 5.7%, but was observed at 11.9% of GPi lead placements, and 10.7% of dystonia patients with only 4.6% of STN lead placements. Total extension revision was at 2.5%, but observed at 5.3% for dystonia patients and at only 1.4% for ET patients. Overall infection rate was at 1.9% with the highest rate observed in dystonia and ET patients. Postoperative complications with hardware, erosion, infection, and delayed stimulation failure were observed more often with ET and dystonia than with PD. This difference was statistically significant between dystonia and PD (p < 0.03) but not between the other disease entities (p > 0.05). On multivariate analysis, age and gender had no correlation with these complications. PD had significantly fewer complications on forward selection regression analysis (p = 0.004). Asymptomatic intracerebral hemorrhage was at 2.5% with the majority in Vim and none observed in GPi placements. There was only one symptomatic hemorrhage with a permanent deficit. Infarcts were observed at 0.8%. There were no mortalities.
This large series of patients and long-term follow-up demonstrate that risks of complications are not universal among movement disorder patients. Diagnosis and lead location are important risk stratification factors in determining complications.
Stereotactic and Functional Neurosurgery 06/2012; 90(3):173-80. · 1.85 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Surgical site infections (SSIs) are the most common nosocomial infections. These complications lead to revision surgery, delayed wound healing, increased use of antibiotics, and increased length of hospital stay, all of which have a significant impact on patients and the cost of health care. Such intraoperative factors as proper skin preparation, adherence to sterile technique, surgical duration, and traffic in the operating room contribute more to SSIs than do patient-related risk factors such as diabetes mellitus, obesity, and preexisting colonization with methicillin-resistant Staphylococcus aureus. Surgeons have a responsibility to understand the current evidence regarding the factors that affect the rates of SSIs so as to provide the highest level of patient care.
The Journal of the American Academy of Orthopaedic Surgeons 02/2012; 20(2):94-101. · 2.66 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: With the growing applications for deep brain stimulators (DBS) in recent years, interest in using DBS as an option for patients with epilepsy has increased. Thalamic DBS appears to be a viable minimally invasive treatment for patients experiencing medically intractable seizures. Thalamic DBS has been associated with significant reduction in seizure frequency and an improvement in overall quality of life, especially in patients who have failed maximal antiepileptic drugs or other surgical alternatives. However, further work is necessary to identify the subgroups of patients experiencing medically intractable seizures who may benefit from DBS, and also to indentify optimal stimulation parameters and mode of stimulation.
Neurosurgery clinics of North America 10/2011; 22(4):457-64, v-vi. · 1.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The intracarotid amobarbital procedure (IAP) has been used for more than half a century to determine language dominance and to assess risk for amnesia after anterior temporal lobectomy. However, because of the risk associated with angiography and the development of noninvasive techniques, the need for the IAP when evaluating patients for epilepsy surgery can now be questioned. The purpose of this review is to examine the clinical indications and efficacy of the Wada test in the preoperative evaluation of epilepsy surgery candidates. This article summarizes a debate that took place during the 2009 American Epilepsy Society (AES) annual course.
Epilepsy & Behavior 02/2011; 20(2):209-13. · 2.34 Impact Factor
-
Der Notarzt 02/2011; 3(2):175-8. · 0.28 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The use of cervical spinal cord stimulators for the treatment of refractory neck and upper extremity pain is widely accepted and growing in use as a treatment modality. This case highlights a previously unreported potential complication of spinal cord stimulators.
Analysis of a patient with a cervical spinal cord stimulator presenting with a spinal cord injury. Patient was followed from presentation in the emergency room until 1-year follow-up in the office.
The patient in this case presented after a fall and sustained a cervical spinal cord injury induced by the electrodes of her spinal cord stimulator working as a space occupying mass.
As more patients are undergoing implantation of spinal cord stimulators we must be aware of the long-term risks that can be encountered.
Neuromodulation 01/2011; 14(1):34-6; discussion 36-7. · 1.19 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Neurostimulation is widely accepted for the treatment of refractory Parkinson's disease, essential tremor, and chronic pain. The presence of a cardiovascular implantable electronic device (CIED) might be considered a contraindication for neurostimulators due to the possible interaction between the two devices. The purpose of this study is to report the feasibility and safety of concomitant use of neurostimulators and CIED, and to review surgical and clinical precautions needed to avoid possible interference between the two systems.
A retrospective institutional review board approved chart review of six patients having both a neurostimulator(s) and a CIED was performed. Diagnosis included Parkinson's disease (two) and intractable pain (four). All implantable cardiac devices were set on bipolar sensing mode and bipolar stimulation was chosen for the neurostimulators. In general, both systems were implanted at sites seven inches apart. Electrocardiogram monitoring was observed throughout implantation. Patients were followed up for a mean period of 31.7 months (ranging from 14 to 67 months). An extensive chart review was done and cases from previous reports were compiled.
In all six patients, no acute events occurred during surgery with no interaction or interference noted during implantation of the second device. Subsequent follow-up visits continued to exhibit a lack of interference between the two systems, including normal electrocardiogram studies. Both systems were noted to function at optimal levels. An extensive literature review revealed 57 unique cases previously published reporting the simultaneous use of neurostimulators and a CIED in the same patient. A table summarizing previously cited cases from the literature is provided.
The concomitant use of neurostimulator(s) and permanent pacemaker(s) can be safely performed. Permanent pacemaker should not be considered a general contraindication for neurostimulation therapy. Current literature lacks evidence to determine the safety of concomitant use of neurostimulator(s) and implantable cardioverter defibrillator(s).
Neuromodulation 01/2011; 14(1):20-5; discussion 25-6. · 1.19 Impact Factor
-
JHN Journal.
