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Clinical Research
Available online 6 November 2023
Intracerebral hemorrhage after deep brain stimulation surgery guided with microelectrode recording: analysis of 297 procedures
Hemorragia intracerebral después de cirugía de estimulación cerebral profunda guiada por microrregistro: un análisis de 297 procedimientos
Beatriz Dos Santosa,
Corresponding author
beatrizmarianasantos@gmail.com

Corresponding author.
, Rui Vaza,b, Ana Cristina Bragac, Manuel Ritob, Diana Lucasb, Clara Chamadoiraa,b
a Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
b Neurosurgery Department, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
c ALGORITMI Centre, University of Minho, Guimarães, Portugal
Received 19 June 2023. Accepted 13 September 2023
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Tables (3)
Table 1. Features of the population in this study.
Table 2. Summarized data of intracerebral haemorrhage.
Table 3. Profiles of the patients who had intracerebral haemorrhage.
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Abstract
Objectives

Report the incidence of symptomatic and asymptomatic intracerebral hemorrhage (ICH) in patients submitted to deep brain stimulation (DBS) guided with microelectrode recording (MER) with further analysis of potential risk factors, both inherent to the patient and related to the pathology and surgical technique.

Methods

We performed a retrospective observational study. 297 DBS procedures were concluded in 277 patients in a single hospital centre between January 2010 and December 2020. All surgeries were guided with MER. We analysed the incidence of symptomatic and asymptomatic ICH and its correlation to age, sex, diagnosis, hypertension and perioperative hypertension, diabetes, dyslipidaemia, antiplatelet drugs, anatomic target, and number of MER trajectories.

Results

There were a total of 585 electrodes implanted in 277 patients. 16 ICH were observed, of which 6 were symptomatic and 10 asymptomatic, none of which incurred in permanent neurological deficit. The location of the hemorrhage varied between cortical and subcortical plans, always in relation with the trajectory or the final position of the electrode. The incidence of symptomatic ICH per lead-implantation was 1%, and the CT-scan demonstrated asymptomatic ICH in 1.7% more patients. Male patients or with hypertension are 2.7 and 2.2 times more likely to develop ICH, respectively. However, none of these characteristics has been shown to have a statistically significant association with the occurrence of ICH, as well as age, diagnosis, diabetes, dyslipidaemia, antiplatelet drugs, anatomic target, number of MER trajectories and perioperative hypertension.

Conclusions

MER-guided DBS is a safe technique, with low incidence of ICH and no permanent deficits in our study. Hypertension and male sex seem to be risk factors for the development of ICH in this surgery. Nevertheless, no statistically significant factors were found for the occurrence of this complication.

Keywords:
Deep brain stimulation
Microelectrode recording
Intracerebral hemorrhage
Risk factors
Abbreviations:
DBS
MER
ICH
STN
GPi
VIM
VOA
CT-scan
Resumen
Objetivos

Reportar la incidencia de hemorragia intracerebral (HIC) sintomática y asintomática en pacientes sometidos a estimulación cerebral profunda (ECP) guiada por microrregistro (MER), con el consecuente análisis de posibles factores de riesgo, tanto inherentes al paciente como relacionados con la patología y técnica quirúrgica.

Métodos

Realizamos un estudio observacional retrospectivo. Se analizaron un total de 297 procedimientos de ECP realizados en 277 pacientes en un centro hospitalario entre enero de 2010 y diciembre de 2020. Todas las cirugías fueron guiadas con MER. Analizamos la incidencia de HIC, tanto sintomática como asintomática, y la correlación con edad, sexo, diagnóstico, hipertensión arterial e intraoperatoria, diabetes, dislipemia, medicación antiplaquetaria previa, diana anatómica y número de vías.

Resultados

El número total de electrodos implantados fue de 585 en 277 pacientes. Se observaron 16 HIC, de las cuales 10 fueron asintomáticas y 6 sintomáticas y ninguna incurrió en déficit neurológico permanente. La localización de la hemorragia varió entre planos corticales y subcorticales, siempre en relación con el trayecto o posición final del electrodo. La incidencia de hemorragia sintomática fue de alrededor del 1 %, y la TC posoperatoria demostró hemorragia asintomática en un 1,7 % adicional de los pacientes. Los pacientes varones o los pacientes con hipertensión tienen 2,7 y 2,2 veces más probabilidades de desarrollar sangrado, respectivamente. Sin embargo, ninguna de estas características demostró una asociación estadísticamente significativa con la ocurrencia de hemorragia intracerebral, como la edad, el diagnóstico, la diabetes, la dislipidemia, la ingesta previa de medicamentos antiplaquetarios, el objetivo anatómico, el número de MER y las vías de HTA intraoperatorias.

Conclusión

La ECP con MER es una técnica segura, con baja incidencia de HIC y sin déficits permanentes en nuestro estudio. La hipertensión arterial y el género masculino parecen ser factores de riesgo para el desarrollo de HIC en esta cirugía. Sin embargo, no se encontraron factores estadísticamente significativos para el aumento en la ocurrencia de esta complicación.

Palabras clave:
Estimulación cerebral profunda
Microrregistro
Hemorragia intracerebral
Factores de riesgo

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