====== Deep brain stimulation complications ====== Imprecise [[Burr Hole]] Placement ((Urakov TM, Jagid JR. Mathematical Equation for Precise Burr Hole Placement in Stereotactic Deep Brain Stimulation Lead Placement. J Neurol Surg A Cent Eur Neurosurg. 2017 Jul 27. doi: 10.1055/s-0037-1604287. [Epub ahead of print] PubMed PMID: 28750452. )). Hardware-related complications frequently occur in deep brain stimulation. Deep brain stimulation hardware infection see [[Traumatic intracerebral hemorrhage after deep brain stimulation]]. Two DBS electrodes were removed from two patients for reasons other than DBS system impairment and were analyzed by a scanning electron microscope and by an energy-dispersive X-ray spectroscopy. The results were compared to a malfunctioning device and to a new device, previously analyzed by our group. The analysis revealed that the wear of the polyurethane external part of all the electrodes was directly correlated with the duration of implantation period. Moreover, these alterations were independent from the electrodes functioning and from parameters used during therapy ((Rizzi M, De Benedictis A, Messina G, Cordella R, Marchesi D, Messina R, Penner F, Franzini A, Marras CE. Comparative analysis of explanted DBS electrodes. Acta Neurochir (Wien). 2015 Sep 7. [Epub ahead of print] PubMed PMID: 26347045. )). ---- Seven hundred twenty-eight patients received 1333 new DBS electrodes and 1218 new internal pulse generators (IPGs) in a total of 1356 stereotactic procedures for the treatment of movement disorders. Seventy-eight percent of the patients had staged lead and IPG implantations. Of the 728 patients, 452 suffered from medically refractory Parkinson's disease; in the other patients, essential tremor (144), dystonia (64), mixed disease (30), and other hyperkinetic movement disorders (38) were diagnosed. Severe intraoperative adverse events included vasovagal response in 6 patients (0.8%), hypotension in 2 (0.3%), and seizure in 2 (0.3%). Postoperative imaging confirmed asymptomatic intracerebral hemorrhage (ICH) in 4 patients (0.5%), asymptomatic intraventricular hemorrhage in 25 (3.4%), symptomatic ICH in 8 (1.1%), and ischemic infarction in 3 (0.4%), associated with hemiparesis and/or decreased consciousness in 13 (1.7%). Long-term complications of DBS device implantation not requiring additional surgery included hardware discomfort in 8 patients (1.1%) and loss of desired effect in 10 (1.4%). Hardware-related complications requiring surgical revision included wound infections in 13 patients (1.7%), lead malposition and/or migration in 13 (1.7%), component fracture in 10 (1.4%), component malfunction in 4 (0.5%), and loss of effect in 19 (2.6%). The authors confirmed that the overall risk of both procedure- and hardware-related adverse events is acceptably low. They offer advice on how to avoid the most common complications ((Fenoy AJ, Simpson RK Jr. Risks of common complications in deep brain stimulation surgery: management and avoidance. J Neurosurg. 2014 Jan;120(1):132-9. doi: 10.3171/2013.10.JNS131225. Epub 2013 Nov 15. PubMed PMID: 24236657. )). ===== Pneumocephalus ===== [[Pneumocephalus after Deep Brain Stimulation]]. ===== Brain edema ===== Postoperative [[brain edema]] around a [[deep brain stimulation]] (DBS) [[electrode]] is an uncommon reported [[complication]]. A retrospective chart review was performed on all patients who underwent DBS electrode implantation over a 3-year period. Routine CT imaging on postoperative day (POD) 1 was negative. Patients were identified based on clinical neurological changes, leading to imaging and subsequent diagnosis. Five of 145 patients (3.4%) presented with new neurological symptoms from POD 1 to 14, which were confirmed by CT imaging to show perilead and/or subcortical edema around 6 of 281 electrodes (2.1%). Four of 5 patients had unilateral edema despite bilateral implantation. Clinical presentations varied widely. Two patients presenting on POD 1 with deteriorating conditions required longer inpatient stays with supportive measures than those presenting later (p = 0.0002). All patients were treated with corticosteroids and returned to baseline by 3 months after surgery. Acute instances of DBS lead edema may occur as early as POD 1 and can rapidly progress into profound deficits. Treatment with supportive care and corticosteroids is otherwise identical to those cases presenting later ((Fenoy AJ, Villarreal SJ, Schiess MC. Acute and Subacute Presentations of Cerebral Edema following Deep Brain Stimulation Lead Implantation. Stereotact Funct Neurosurg. 2017 Feb 17;95(2):86-92. doi: 10.1159/000454892. [Epub ahead of print] PubMed PMID: 28208150. )). ===== Readmission ===== see [[Deep Brain Stimulation readmission]]. ===== Infections ===== [[Deep brain stimulation infections]]