Minimising the rate of vascular complications in Deep Brain Stimulation surgery for the management of Parkinson's disease: a single-centre 600-patient case series.

Autor:	Cook R; Neurosurgery, North Shore Private Hospital, Sydney, NSW, Australia.; Neurosurgery, Royal North Shore Hospital, Sydney, New South Wales, Australia., Chennell Dutton N; Physiotherapy, North Shore Private Hospital, Sydney, New South Wales, Australia., Silburn PA; Movement Neuroscience Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.; Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia., Meagher LJ; Neuropsychiatry, North Shore Private Hospital, Sydney, NSW, Australia., Fracchia G; Neurosurgery, North Shore Private Hospital, Sydney, NSW, Australia., Anderson N; Radiology, North Shore Private Hospital, Sydney, New South Wales, Australia., Cooper G; Radiology, North Shore Private Hospital, Sydney, New South Wales, Australia., Dinh HM; Neurology, Royal North Shore Hospital, Sydney, New South Wales, Australia., Cook SJ; University College Dublin, Dublin, Ireland., Silberstein P; Neurology, Royal North Shore Hospital, Sydney, New South Wales, Australia.; Neurology, North Shore Private Hospital, Sydney, NSW, Australia.
Jazyk:	angličtina
Zdroj:	BMJ neurology open [BMJ Neurol Open] 2024 Oct 26; Vol. 6 (2), pp. e000793. Date of Electronic Publication: 2024 Oct 26 (Print Publication: 2024).
DOI:	10.1136/bmjno-2024-000793
Abstrakt:	Objectives: Deep Brain Stimulation (DBS) is an effective, yet underused therapy for people living with Parkinson's disease (PD) in whom tremor, motor fluctuations and/or dyskinesia are not satisfactorily controlled by oral medical therapy. Fear of vascular complications related to the operative procedure remains a strong reason for both the referrer and patient reluctance. We review the incidence of vascular complications in the first 600 patients with Parkinson's disease treated at our centre by a single neurologist/neurosurgical team. Methods: Surgical data routinely collected for patients who underwent DBS implantation for the management of PD between the years 2001-2023 was retrospectively reviewed. Incidences of vascular complication were analysed in detail, examining causal factors. Results: Including reimplantations, 600 consecutive DBS patients underwent implantation with 1222 DBS electrodes. Three patients (0.50%) experienced vascular complications. Conclusion: This vascular complication rate is at the low end of that reported in the literature. Risk mitigation strategies discussed include a consistent neurosurgical team, dual methodology target and trajectory planning, control of cerebrospinal fluid egress during the procedure, use of a specialised microelectrode recording (MER)/macrostimulation electrode without an introducing brain cannula and low number of MER passes. A reduced vascular complication rate may improve the acceptability of DBS therapy for both patients and referrers. Competing Interests: No, there are no competing interests. (Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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