Single-Stage Deep Brain Stimulator Placement for Movement Disorders: A Case Series.

Arrin Brooks,Alastair T Hoyt

doi:10.3390/brainsci11050592

Arrin Brooks, Alastair T Hoyt

Open Access

https://doi.org/10.3390/brainsci11050592

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Journal: Brain sciences	Publication Date: May 3, 2021
Citations: 3	License type: CC BY 4.0

Affiliation: Marshall University

Abstract

With more than two decades of experience and thousands of patients treated worldwide, deep brain stimulation (DBS) has established itself as an efficacious and common surgical treatment for movement disorders. However, a substantial majority of patients in the United States still undergo multiple, “staged” surgeries to implant a DBS system. Despite several reports suggesting no significant difference in complications or efficacy between staged and non-staged approaches, the continued use of staging implies surgeons harbor continued reservations about placing all portions of a system during the index procedure. In an effort to eliminate multiple surgeries and simplify patient care, DBS implantations at our institution have been routinely performed in a single surgery over the past four years. Patients who underwent placement of new DBS systems at our institution from January 2016 to June 2019 were identified and their records were reviewed. Revision surgeries were excluded. Total operative time, length of stay and rates of surgical site infections, lead fracture or migration, and other complications were evaluated. This series expands the body of evidence suggesting placement of a complete DBS system during a single procedure appears to be an efficacious and well-tolerated option.

Highlights

Deep brain stimulation (DBS) therapy has become a mainstay for movement disorders including essential tremor, Parkinson’s disease (PD), and dystonia [1]
A 2013 international survey of DBS procedural steps revealed that DBS implantations occurring in the United States were more likely to be staged than those at European centers [3]
In America, 65% percent of DBS surgeries were staged in 2 days, 22% staged in 3 days and only 13% were performed in a single stage

Summary

Introduction

Deep brain stimulation (DBS) therapy has become a mainstay for movement disorders including essential tremor, Parkinson’s disease (PD), and dystonia [1]. More than 160,000 patients have been implanted worldwide and more than 12,000 new patients receive DBS annually [2]. Patients are frequently offered implantation via multiple, “staged” surgeries. In America, 65% percent of DBS surgeries were staged in 2 days, 22% staged in 3 days and only 13% were performed in a single stage. Reasons to separate DBS implantation into multiple surgeries vary, including concerns for increased risk of infection, poor stimulation efficacy, and postoperative confusion leading to increased length of stay, when intraoperative microelectrode (MER)

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