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Deep-brain stimulation: long-term analysis of complications caused by hardware and surgery—experiences from a single centre

Department of Stereotaxy and Functional Neurosurgery, University Köln, Köln, Germany

Correspondence to:
Correspondence to:
Professor Dr Jürgen Voges
Department of Stereotaxy and Functional Neurosurgery, University Köln, Kerpenerstr 62, 50924 Köln, Germany; j.voges{at}uni-koeln.de

Objective: To determine the surgery-related and hardware-related complications of deep-brain stimulation (DBS) at a single centre.

Methods: 262 consecutive patients (472 electrodes) operated for DBS in our department from February 1996 to March 2003 were retrospectively analysed to document acute adverse events (30 days postoperatively). The data of 180 of these patients were additionally revised to assess long-term complications (352 electrodes, mean follow-up 36.3 (SD 20.8) months).

Results: The frequency of minor intraoperative complications was 4.2% (11/262 patients). Transient (0.2%) or permanent (0.4%) neurological deficits, and in one case asymptomatic intracranial haemorrhage (0.2%), were registered as acute severe adverse events caused by surgery. Among minor acute complications were subcutaneous bleeding along the extension wire (1.2%) and haematoma at the pulse generator implantation site (1.2%). Skin infection caused by the implanted material was registered in 15 of 262 patients (5.7%). The infection rate during the first observation period was 1.5% (4/262 patients) and the late infection rate was 6.1% (11/180 patients). Partial or complete removal of the stimulation system was necessitated in 12 of 262 (4.6%) patients because of skin infection. During the long-term observation period, hardware-related problems were registered in 25 of 180 (13.9%) patients.

Conclusions: Stereotactic implantation of electrodes for DBS, if performed with multiplanar three-dimensional imaging and advanced treatment planning software, is a safe procedure with no mortality and low morbidity. The main causes for the patients’ prolonged hospital stay and repeated surgery were wound infections and hardware-related complications.

Abbreviations: BMI, body mass index; DBS, deep-brain stimulation; fMRI, functional MRI; ICH, intracranial haemorrhage; IPG, implantable pulse generator; MER, microelectrode recording; OCD, obsessive–compulsive disorders; STN, subthalamic nucleus