Deep brain stimulation for movement disorders: morbidity and mortality in 109 patients
Deep brain stimulation for movement disorders: morbidity and mortality in 109 patients
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DOI：
10.3171/jns.2003.98.4.0779
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发表时间：
2003-04-01
影响因子：
4.1
通讯作者：
Baltuch, GH
中科院分区：
文献类型：
--
作者：
Umemura, A;Jaggi, JL;Baltuch, GH
对象。脑深部电刺激（DBS）被认为是治疗医学上难治性运动障碍的一种比烧蚀立体定向手术更有效、发病率更低的替代方法。然而，与手术相关的发病率和死亡率的确切发生率尚不清楚。在本研究中，作者回顾了大量DBS手术的手术发病率和死亡率。作者回顾性分析了1998年7月至2002年4月在同一中心同一外科团队对109例患者进行179例DBS植入的手术并发症。平均随访时间为20个月。14例（12.8%）患者发生16例与手术相关的严重不良事件。围手术期死亡2例（1.8%），1例因肺栓塞，2例因吸入性肺炎。其他不良事件包括2例肺栓塞、2例皮质下出血、2例慢性硬膜下血肿、1例静脉梗死、1例癫痫发作、4例感染、1例脑脊液漏和1例皮肤糜烂。永久性后遗症发生率为4.6%（109例患者中有5例）。器械相关并发症的发生率，如感染或皮肤糜烂，也为4.6%（109例患者中有5例）。与DBS手术相关的不良事件发生率很高。然而，DBS在精心挑选的患者中是有效的，应该认真考虑将其作为难治性运动障碍患者的治疗选择。
Object. Deep brain stimulation (DBS) has been advocated as a more highly effective and less morbidity-producing alternative to ablative stereotactic surgery in the treatment of medically intractable movement disorders. Nevertheless, the exact incidence of morbidity and mortality associated with the procedure is not well known. In this study the authors reviewed the surgical morbidity and mortality rates in a large series of DBS operations.Methods. The authors retrospectively analyzed surgical complications in their consecutive series of 179 DBS implantations in 109 patients performed by a single surgical team at one center between July 1998 and April 2002. The mean follow-up period was 20 months. There were 16 serious adverse events related to surgery in 14 patients (12.8%).There were two perioperative deaths (1.8%), one caused by pulmonary embolism and the second due to aspiration pneumonia. The other adverse events were two pulmonary embolisms, two subcortical hemorrhages, two chronic subdural hematomas, one venous infarction, one seizure, four infections, one cerebrospinal fluid leak, and one skin erosion. The incidence of permanent sequelae was 4.6% (five of 109 patients). The incidence of device-related complications, such as infection or skin erosion, was also 4.6% (five of 109 patients).Conclusions. There is a significant incidence of adverse events associated with the DBS procedure. Nevertheless, DBS is clinically effective in well-selected patients and should be seriously considered as a treatment option for patients with medically refractory movement disorders.