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Magnetic resonance-based deep brain stimulation technique: a series of 478 consecutive implanted electrodes with no perioperative intracerebral hemorrhage.

AbstractOBJECTIVE:
The aim of this study was to determine the safety of a deep brain stimulation technique consisting of a combination of routine general anesthesia, magnetic resonance imaging direct targeting, and a single penetration technique in a large population of patients undergoing operation for movement disorders.
METHODS:
One hundred ninety-four patients treated with deep brain stimulation between 1996 and 2007 were assessed via a computerized database for intra- and perioperative events. Most patients were young; only 62 of them were older than 40 years (mean age, 31.1 years). General anesthesia was induced in all cases before placement of a magnetic resonance imaging-compatible stereotactic frame. Electrode implantation was done under radioscopic control via a rigid immobile cannula using a single cerebral perforation. No perioperative microelectrode recording or neurostimulation testing was used. Systematic postoperative magnetic resonance imaging was performed before frame removal.
RESULTS:
A total of 478 electrodes were implanted in 220 procedures: 426 for dystonic-dyskinetic syndromes and 52 for Parkinson disease. The mean number of parenchymal penetrations per patient was 2.5 for the dystonic-dyskinetic syndrome group and 2.08 for the Parkinson disease group. Postimplantation magnetic resonance imaging detected no perioperative intraparenchymal hemorrhages.
CONCLUSION:
We consider that the risk of hemorrhagic complication is multifactorial but closely related to the chosen technique.
AuthorsIgor Lima Maldonado, Thomas Roujeau, Laura Cif, Victoria Gonzalez, Hassan El-Fertit, Xavier Vasques, Alain Bonafe, Phillippe Coubes
JournalNeurosurgery (Neurosurgery) Vol. 65 Issue 6 Suppl Pg. 196-201; discussion 201-2 (Dec 2009) ISSN: 1524-4040 [Electronic] United States
PMID19934995 (Publication Type: Journal Article)
Topics
  • Adolescent
  • Adult
  • Aged
  • Brain (anatomy & histology, physiopathology, surgery)
  • Child
  • Child, Preschool
  • Deep Brain Stimulation (adverse effects, methods)
  • Electrodes, Implanted (adverse effects, standards)
  • Female
  • Humans
  • Iatrogenic Disease (prevention & control)
  • Intraoperative Complications (etiology, physiopathology, prevention & control)
  • Magnetic Resonance Imaging (methods)
  • Male
  • Middle Aged
  • Monitoring, Intraoperative (methods)
  • Movement Disorders (therapy)
  • Neural Pathways (anatomy & histology, physiopathology, surgery)
  • Neuronavigation (methods)
  • Postoperative Hemorrhage (etiology, physiopathology, prevention & control)
  • Stereotaxic Techniques (adverse effects)
  • Young Adult

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