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Dr. Okun

Post of Week: Reducing Bleeds From DBS

4 posts in this topic

Dear forum members,

 

One issue in DBS is that there is a hemorrhage (bleeding) risk from the surgery. Several groups have been studying different approaches to DBS that may decrease bleeding risk. This is a small study from Korea. Hopefully as more data emerges techniques will evolve. Here is the abstract,

 

 

Acta Neurochir (Wien). 2011 Apr 9. [Epub ahead of print]

Analysis of hemorrhagic risk factors during deep brain stimulation surgery for movement disorders: comparison of the circumferential paired and multiple electrode insertion methods.

Park JH, Chung SJ, Lee CS, Jeon SR.

 

Center for Parkinson and Alzheimer's Disease, Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736, Korea.

Abstract

BACKGROUND: The most serious complication of deep brain stimulation (DBS) surgery is intracranial hemorrhage. The authors have assessed risk factors for hemorrhage in DBS surgery and compared two types of microelectrode insertion technique on hemorrhagic risk.

 

METHODS: A total of 171 DBS procedures were performed on 110 patients (58 females, 52 males) by the same neurosurgeon at a single center between May 2005 and May 2010. We used two microelectrode insertion methods: multiple microelectrode insertion (MMI) and circumferential paired microelectrode insertion (CPMI). We analyzed the correlation between bleeding rates and gender, age, hypertension, target location, simultaneous bilateral procedure and electrode insertion method.

 

RESULTS: Of the 171 DBS procedures, 138 were on 85 patients with Parkinson's disease, 16 were in 15 patients with essential tremor and 17 were on ten patients with dystonia. There were nine postoperative hemorrhagic events (5.26%), of which three were symptomatic (1.75%), and one permanent neurological deficit event (0.58%). Compared with the bleeding rate in the MMI method (9/106, 8.5%), there was no instance of bleeding with the CPMI method (0/65, 0%) (p = 0.04). In other factors, the correlation with hemorrhage was not found.

 

CONCLUSION: Use of the CPMI method significantly decreased the rate of bleeding. This new surgical technique seems to be safe and accurate and may be recommended as another surgical option.

 

PMID: 21476122 [PubMed - as supplied by publisher]

 

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Deep brain stimulation (DBS) is a procedure used to treat Parkinson's patients. It is designed to help them with their tremors, slowed movement and walking problems. DBS uses electrical currents to "jam" abnormal brain signals.

 

DBS involves the implantation of a battery-operated neurotransmitter under the collarbone. Attached to this device is a pacemaker-like wire with an electrode at the tip. This wire is inserted just under the skin and led along the length of the neck up to the scalp, where it is placed through a small hole in the skull. The electrode tip is implanted in the target brain center.

 

Once in place, electrical impulses are sent from the neurotransmitter up along the wire to the brain. These impulses interfere with and block the electrical signals that cause tremors and other symptoms. Studies have shown that DBS significantly reduces tremors and other movement-interfering symptoms in about two-thirds of all Parkinson's patients.

Edited by Dr. Okun

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