Supplementary Material for: Surgical Complications in Subthalamic Nucleus Deep Brain Stimulation for Parkinson’s Disease: experience in 800 patients

Introduction. We present our surgical complications resulting in neurological deficit or additional surgery during 25 years of DBS of the subthalamic nucleus (STN) for Parkinson’s Disease (PD).
Methods. We conducted a retrospective chart review of all PD patients that received STN DBS in our DBS center between 1998 and 2023. Outcomes were complications resulting in neurological deficit or additional surgery. Potential risk factors (number of microelectrode recording tracks, age, anesthesia method, hypertension, and sex,) for symptomatic intracerebral hemorrhage (ICH) were analyzed. Furthermore, lead fixation techniques were compared.
Results. Eight hundred PD patients (507 men, 293 women) received unilateral (n=11) or bilateral (n=789) implantation of STN electrodes. Neurological deficit due to ICH, edema, delirium or infarction was seen in 8.4% of the patients (7.4% transient, 1.0% permanent). Twenty-two patients (2.8%) had a symptomatic ICH following STN DBS, for which we did not find any risk factors, and five had permanent sequelae due to ICH (0.6%). Of all patients, 18.4% required additional surgery; the proportion was reduced from 27% in the first 300 cases to 13% in the last 500 cases (p<0.001). The infection rate was 3.5%, which decreased from 5.3% in the first 300 cases to 2.2% in the last 500 cases. The use of a lead anchoring device led to significantly less lead migrations than miniplate fixation.
Conclusion. STN DBS leads to permanent neurological deficit in a small number of patients (1.0%), but a substantial proportion needs some additional surgical procedure after the first DBS system implantation. The risk of revision surgery was reduced over time, but remained significant. These findings need to be discussed with the patient in the preoperative informed consent process in addition to the expected health benefit.

引言。本文报告了1998年至2023年25年间，本中心为帕金森病（Parkinson’s Disease, PD）患者实施丘脑底核（Subthalamic Nucleus, STN）脑深部电刺激术（Deep Brain Stimulation, DBS）期间，引发神经功能缺损或需再次手术的手术并发症相关数据。
方法。本研究对1998年至2023年间在本DBS中心接受STN-DBS手术的所有PD患者的病历资料进行回顾性分析。研究结局为导致神经功能缺损或需再次手术的手术并发症。本研究分析了症状性脑出血（Intracerebral Hemorrhage, ICH）的潜在危险因素，包括微电极记录通道数量、患者年龄、麻醉方式、高血压病史及性别。此外，本研究还对比了不同电极固定技术的临床效果。
结果。共计800例PD患者（男性507例，女性293例）接受了单侧（n=11）或双侧（n=789）STN电极植入术。其中8.4%的患者出现因脑出血、脑水肿、谵妄或脑梗死导致的神经功能缺损，该类缺损中7.4%为一过性，1.0%为永久性。22例患者（2.8%）在STN-DBS术后出现症状性ICH，但未发现明确相关危险因素；其中5例患者因ICH遗留永久性后遗症（占比0.6%）。所有患者中18.4%需接受再次手术，该比例从前300例患者的27%下降至后500例患者的13%（p<0.001）。术后感染率为3.5%，同样从前期300例的5.3%下降至后期500例的2.2%。使用电极锚定装置的患者，其电极移位发生率显著低于微型钢板固定组。
结论。STN-DBS手术仅会在少数患者中导致永久性神经功能缺损（占比1.0%），但仍有相当比例的患者在首次DBS系统植入术后需接受额外手术干预。翻修手术的风险随时间推移有所降低，但仍处于较高水平。除向患者告知手术预期健康获益外，术前知情同意过程中还需与患者充分讨论上述手术风险。