TY - JOUR
T1 - Acute ischemic stroke during deep brain stimulation surgery of globus pallidus internus
T2 - Report of 5 cases
AU - Downes, Angela E.
AU - Pezeshkian, Patrick
AU - Behnke, Eric
AU - Bordelon, Yvette
AU - Tagliati, Michele
AU - Mamelak, Adam
AU - Pouratian, Nader
N1 - Funding Information:
MRI anatomic illustration was created by Zach Folzenlogen, MD, of University of Colorado, Department of Neurosurgery.
Funding Information:
Nader Pouratian has fellowship support from Medtronic. The other authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
Publisher Copyright:
© 2016 by the Congress of Neurological Surgeons.
PY - 2016
Y1 - 2016
N2 - BACKGROUND: Cerebrovascular accident (CVA) is a potentially devastating complication of deep brain stimulation (DBS) surgery. Although there are substantial data reporting the incidence and cause of hemorrhagic CVA, reports of acute ischemic infarctions during DBS implantation surgery are rare. OBJECTIVE: To present a series of 5 patients who experienced clinically significant ischemic CVA during microelectrode-guided globus pallidus internus (GPi) DBS, and evaluate the potential risk factors and mechanisms. METHODS: A retrospective analysis of GPi DBS surgeries performed between June 2010 and February 2015 at UCLA Medical Center and June 2010 and February 2014 at Cedars- Sinai Medical Centers was performed to identify stroke risk factors. Statistical analysis was performed, comparing the stroke group with all patients undergoing GPi DBS. RESULTS: All 5 patients developed acute onset of lethargy, dysarthria, and contralateral facial and/or hemibody weakness intraoperatively. Computed tomographic scans in all cases were negative for hemorrhage. Magnetic resonance images obtained in 3 patients revealed infarction in the posterior limb of the internal capsule. During the time period analyzed, a total of 234 GPi leads were placed in 129 patients, yielding a 2.14% rate of ischemic stroke per lead. No statistically significant risk factors were identified in the stroke group. Given the variability of symptom onset during surgery, the mechanism is not clear, but it could be related to compression, compromise, or vasospasm of lenticulostriate arteries and/or anterior choroidal branches near the GPi target. CONCLUSION: Ischemic stroke in GPi DBS is a significant complication for clinicians to be aware of and discuss with their patients preoperatively.
AB - BACKGROUND: Cerebrovascular accident (CVA) is a potentially devastating complication of deep brain stimulation (DBS) surgery. Although there are substantial data reporting the incidence and cause of hemorrhagic CVA, reports of acute ischemic infarctions during DBS implantation surgery are rare. OBJECTIVE: To present a series of 5 patients who experienced clinically significant ischemic CVA during microelectrode-guided globus pallidus internus (GPi) DBS, and evaluate the potential risk factors and mechanisms. METHODS: A retrospective analysis of GPi DBS surgeries performed between June 2010 and February 2015 at UCLA Medical Center and June 2010 and February 2014 at Cedars- Sinai Medical Centers was performed to identify stroke risk factors. Statistical analysis was performed, comparing the stroke group with all patients undergoing GPi DBS. RESULTS: All 5 patients developed acute onset of lethargy, dysarthria, and contralateral facial and/or hemibody weakness intraoperatively. Computed tomographic scans in all cases were negative for hemorrhage. Magnetic resonance images obtained in 3 patients revealed infarction in the posterior limb of the internal capsule. During the time period analyzed, a total of 234 GPi leads were placed in 129 patients, yielding a 2.14% rate of ischemic stroke per lead. No statistically significant risk factors were identified in the stroke group. Given the variability of symptom onset during surgery, the mechanism is not clear, but it could be related to compression, compromise, or vasospasm of lenticulostriate arteries and/or anterior choroidal branches near the GPi target. CONCLUSION: Ischemic stroke in GPi DBS is a significant complication for clinicians to be aware of and discuss with their patients preoperatively.
KW - Complications
KW - Deep brain stimulation
KW - Globus pallidus internus
KW - Ischemia
KW - Stroke
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U2 - 10.1227/NEU.0000000000001359
DO - 10.1227/NEU.0000000000001359
M3 - Article
C2 - 29506283
AN - SCOPUS:85037637563
SN - 2332-4252
VL - 12
SP - 383
EP - 390
JO - Operative Neurosurgery
JF - Operative Neurosurgery
IS - 4
ER -