Abstract
Background: Hemodynamic perturbations can be anticipated in deep brain stimulation (DBS) surgery and may be attributed to multiple factors. Acute changes in hemodynamics may produce rare but severe complications such as intracranial bleeding, transient ischemic stroke and myocardium infarction. Therefore, this retrospective study attempts to determine the incidence of hemodynamic perturbances (rate) and related risk factors in patients undergoing DBS surgery.Materials and Methods: After institutional approval, all patients undergoing DBS surgery for the past 10 years were recruited for this study. Demographic characteristics, procedural characteristics and intraoperative hemodynamic changes were noted. Event rate was calculated and the effect of all the variables on hemodynamic perturbations was analyzed by regression model.Results: Total hemodynamic adverse events during DBS surgery was 10.8 (0–42) and treated in 57% of cases.Conclusion: Among all the perioperative variables, the baseline blood pressure including systolic, diastolic, and mean arterial pressure was found to have highly significant effect on these intraoperative hemodynamic perturbations.
Highlights
Deep brain stimulation (DBS) has become an established surgical therapy for patients with Parkinson’s disease (PD) who are refractory to standard medical management, as well as being used for other chronic neurological conditions (Shindo et al, 2013)
Baseline blood pressure including systolic, diastolic and mean arterial pressure was found to have highly significant effect [14, 31, and 19% greater chance of adverse hemodynamic event per 10 mm Hg increase in value respectively] on intraoperative hemodynamic perturbations (Table 2)
Other variables including type of disease, duration of symptoms, number of medications used, type of nuclei stimulated, laterality of DBS implants and battery placement on the same day had no significant effect on hemodynamic perturbations during DBS surgery (Table 3)
Summary
Deep brain stimulation (DBS) has become an established surgical therapy for patients with Parkinson’s disease (PD) who are refractory to standard medical management, as well as being used for other chronic neurological conditions (Shindo et al, 2013) This procedure requires precise stimulation of different thalamic and sub thalamic nuclei, intraoperative neurological monitoring and patient’s cooperation to perform certain neurological examinations (Camerlingo et al, 1990). Acute changes in hemodynamics may produce rare but severe complications such as intracranial bleeding, transient ischemic stroke and myocardium infarction This retrospective study attempts to determine the incidence of hemodynamic perturbances (rate) and related risk factors in patients undergoing DBS surgery
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