Hemorrhagic complications of microelectrode-guided deep brain stimulation

Background: The incidence of intracranial hemorrhage occurring during microelectrode-guided implantation of deep brain stimulators (DBS) for movement disorders has not been well defined. We report the incidence of hemorrhage in a large series of DBS implants into the subthalamic nucleus (STN), thalamus (VIM) and internal globus pallidus (GPi). Methods: All DBS procedures performed by a single surgeon ( P. A. S.) between June 1998 and April 2003 were included in this study. Patients had postoperative imaging (MRI or CT) 4 - 24 h following surgery, and all hematomas >0.2 cm(3) in volume were noted and scored as symptomatic ( associated with any new neurologic deficit lasting 124 h) or asymptomatic. Results: The total number of lead implants was 357. There were 5 symptomatic hematomas and 6 asymptomatic hematomas. The relative risk of hematoma ( any type) per lead implant was 3.1%. The incidence of hematoma by target site was 2.5% per lead for STN-DBS, 6.7% for GPi-DBS and 0% for VIM-DBS. Conclusion: The overall risk of intraoperative or early postoperative symptomatic hemorrhage with microelectrode-guided DBS, over all targets, was 1.4% per lead implant. The brain target had a significant effect on the risk of hemorrhage. Copyright (C) 2003 S. Karger AG, Basel.