Risks of intracranial hemorrhage in patients with Parkinson's disease receiving deep brain stimulation and ablation |
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| Institution: | 1. CNRS, Institut de Pharmacologie Moléculaire et Cellulaire (IPMC), UMR 7275, 06560 Valbonne, France;2. Université de Nice Sophia Antipolis, UMR 7275, 06560 Valbonne, France;3. LabEx Ion Channel Science and Therapeutics, UMR 7275, 06560 Valbonne, France;1. Department of Neurologic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, United States;2. Departments of Neurology and Neurosurgery, University of Florida College of Medicine and McKnight Brain Institute, University of Florida Center for Movement Disorders and Neurorestoration, 3450 Hull Road, 4th Floor, Gainesville, FL 32607, United States;3. Department of Neurosurgery, University of Alabama Birmingham, School of Medicine, Department of Neurosurgery, 510 20th Avenue South, FOT 1038, Birmingham, AL 35234, United States;4. Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, United States;5. Department of Neurological Surgery, University of California San Francisco, 1635 Divisadero Street, 5th Floor, Suite 520-530, San Francisco, CA 94115, United States;6. Departments of Neurological Surgery, University of Florida College of Medicine and McKnight Brain Institute, University of Florida Center for Movement Disorders and Neurorestoration, 3450 Hull Road, 4th Floor, Gainesville, FL 32607, United States;7. Department of Neurology, University of Alabama Birmingham, School of Medicine, 510 20th Avenue South, FOT 1038, Birmingham, AL 35234, United States;8. Neurology Department, University of Rochester, 919 Westfall Rd., Bldg C, Suite 220, Rochester, NY 14618, United States;9. Movement Disorder and Comprehensive Epilepsy Centers, Henry Ford Medical Group, 6777 West Maple Road, West Bloomfield, MI 48322, United States;10. Movement Disorder Group, Columbia University Medical Center, 710 West 168th Street, 3rd Floor, #350, New York, NY 10032, United States;11. Department of Neurology, Baylor College of Medicine, 6550 Fannin Street, Suite 1801, Houston, TX 77030, United States;12. Department of Neurosurgery, The Methodist Hospital Physician Organization, 6560 Fannin, Suite 944, Houston, TX 77030, United States;13. Department of Neurology, Loma Linda University Medical Center, Division of Movement Disorders, 11370 Anderson St, Suite 2400, Loma Linda, CA 92354, United States;14. Department of Neurology, Vanderbilt University, A-0118 Medical Center North, Nashville, TN 37232-2551, United States;15. Department of Neurosurgery, Vanderbilt University, 1211 22nd Ave. S, Nashville, TN 37232, United States;p. Movement Disorder Center, Texas Health Presbyterian Dallas, 8200 Walnut Hill, Dallas, TX 75231, United States;q. Clinical Research Department, St. Jude Medical, 6901 Preston Road, Plano, TX 75024, United States;r. Parkinson''s Disease and Movement Disorder Center, University of Kansas Medical Center, 3599 Rainbow Blvd, Mailstop 2012, Kansas City, KS 66160, United States;s. Surgical Movement Disorders, Department of Neurology, University of California San Francisco and the San Francisco Veteran''s Affairs Medical Center, 1635 Divisadero Street, 5th Floor, Suite 520-530, San Francisco, CA 94115, United States;1. Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan;2. Department of Neurosurgery, Otemae Hospital, Osaka, Japan;3. Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan |
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| Abstract: | ObjectivesThis study analyzed risk factors for hemorrhage in a large series of deep brain stimulation (DBS) and ablation procedures in patients with advanced Parkinson's disease (PD).MethodsSix hundred and forty four subjects with advanced PD treated with DBS or ablation procedures between March 1999 and December 2007 were enrolled in the study. Procedures were performed by the same surgeon, and included DBS in 126 patients, ablation in 507 patients and DBS after prior unilateral ablation procedures in 11 patients. Of 796 target procedures, 207 were DBS including 202 subthalamic nucleus (STN) targets, 3 ventralis intermedius nucleus (Vim) targets and 2 globus pallidus internus (GPi) targets, and the others were 589 ablation procedures including 474 GPi targets and 115 Vim targets. Postoperative CT or MRI was performed in all patients within 24 h of lead implantation or ablation treatment. Statistical correlation analysis of risk factors for intracranial hemorrhage (ICH) was performed by stepwise logistic regression. Explanatory variables were patient age, sex, blood pressure, anatomical targets, the number of microelectrode recording (MER) penetrations and surgical modality.ResultsPostoperative symptomatic ICH occurred in 10 cases (8 pallidotomy and 2 thalamotomy) and asymptomatic ICH in 14 cases (9 pallidotomy, 4 thalamotomy and 1 DBS). Hypertension and surgical modality were significant factors contributing to hemorrhage (both P < 0.05). The likelihood of hemorrhage in hypertensive patients was 2.5 times that in normotensive patients. The risk of hemorrhage during ablation was 5.4 times that in DBS. The number of MER trajectories did not significantly correlate with ICH occurrence (P = 0.07). No statistically significant difference was found in age, sex and anatomical targets.ConclusionThis study demonstrated that hypertension is a risk factor for ICH in PD patients. DBS is generally a safe surgical modality as compared with ablation. Increasing microelectrode trajectories seemed to increase the risk of ICH, but no statistically significant difference was found (P = 0.07). |
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