脑深部刺激手术和硬件相关并发症的防治

How to avoid and manage surgical and hardware-related complications of deep brain stimulation

目的回顾性研究脑深部刺激（deep brain stimulation,DBS）手术和硬件相关并发症的防治。方法 2000年~2008年共有161例病人进行了DBS治疗,其中帕金森病153例,特发性震颤2例,肌张力障碍6例。刺激耙点240个,其中丘脑底核224个,腹中间核8个,苍白球内侧部8个。结果共有25个与手术和硬件相关的并发症,包括术后意识紊乱11例,其中1例继发严重肺部感染,无症状性脑内出血1例,电极定位不准2例,脉冲发生器植入处皮下感染1例,皮肤破溃2例,IPG植入处皮下积液6例,脉冲发生器功能异常1例。没有永久性神经功能缺失并发症。结论术后意识紊乱是双侧同时植入刺激术最常见的并发症,在病情较重的帕金森病病人中更为多见;而其他并发症随着手术经验积累,可以大大降低。

Objective In an attempt to identify and potentially reduce factors leading to the complications of deep brain stimulation（DBS）,we performed a retrospective analysis of the patients receiving this therapy over a nine-year period.Methods There were 161 patients（85 male and 76 female）included in this study who received DBS treatment.153 of the 161 patients were treated for Parkinson＇s disease,2 for essential tremor and 6 for dystonia.The number of DBS targets was 240 including subthalamic nucleus（n=224）,ventralis intermedius nucleus（n=8）and globus pallidus internus（n=8）.We have collected and analyzed the data from these patients,with an emphasis on the complications and factors potentially related to these complications.Results A total of 25 surgical and hardware-related complications occurred in 24 patients,including confusion in 11 cases,1 of which was further complicated by severe pneumonia treated with tracheotomy,asymptomatic intracranial hemorrhage in 1 case,electrode misplacement in 2 cases,infection of the subcutaneous pocket receiving the interal pulse generator（IPG）in 1 case,skin erosion in 2 cases,formation of seroma in the subcutaneous pocket receiving the IPG in 6 cases and device malfunction in 1 case.There was no permanent neurological deficit.Conclusion Confusion is the most common complication for simultaneous bilateral DBS targeting subthalamic nucleus.Other complications could be reduced along with increasing experience of surgeons.