Tag: Patient selection

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The Rate and Risk Factors of Deep Brain Stimulation–Associated Complications

Operative Neurosurgery 28:519–527, 2025

The study investigates complications associated with deep brain stimulation (DBS) surgery, analyzing patient demographics, surgical techniques, and outcomes. It identifies factors influencing complications such as pneumocephalus, infection, and hemorrhage, aiming to improve patient selection and surgical strategies for better outcomes.

• Deep Brain Stimulation (DBS) is a recognized neurosurgical procedure for various neurological disorders, considered safe but not without complications. The study investigates these complications and their association with patient characteristics and surgical techniques.

• The study analyzed 481 patients who underwent DBS lead implantation between January 2012 and January 2020, with a total of 859 leads implanted.

• Common complications included pneumocephalus, edema, altered mental state, and infection. General anesthesia, hypertension, heart disease, and depression were linked to longer postoperative stays.

• High BMI was associated with increased rates of surgery-related infections and lead revision/explantation.

• Intraoperative mean arterial pressure and anesthesia type were significant predictors of postoperative pneumocephalus.

• The study found that certain comorbidities, such as hypertension, heart disease, and depression, were associated with longer hospital stays.

• Older patients were less likely to require lead revision/explantation, while those with high BMI were at higher risk.

• Infection prevention techniques, like vancomycin powder, were effective, with infection rates at the lower end of the reported range.

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Underutilization of deep brain stimulation for Parkinson’s disease?

Acta Neurochir (2017) 159:771–778

Only 10% of the up to 15% of patients with advanced Parkinson’s disease (PD) eligible for deep brain stimulation (DBS) are referred to specialized centers. This survey evaluated the reasons for the reluctance of patients and referring physicians regarding DBS.

Methods: Two different questionnaires containing multiple choice and open verbalized questions were developed, one for neurologists and one for patients with PD. The first questionnaire was sent to 87 neurologists in private practice in the catchment area of the authors’ medical center, the second to patient support groups in the same region with the help of the German Parkinson Association.

Results: Of the addressed neurologists, 56.3% completed the questionnaire; 61.2% of themestimated the risk of intracerebral hemorrhage as the most severe complication at 4.3% on average; 30.6% were concerned about patients developing mood changes or depression after DBS. Only 16.3% felt unable to care for patients after DBS; 61.2% already had personal experience with patients after DBS and reported good clinical outcome in 90.0% of patients. Although 87.8% claimed to know the specific criteria for DBS, only 40.8% could actively describe them. Only 14.0% could state each of the three main criteria. Of the 46 patients, 88.1% completing the questionnaire had obtained information on DBS from regional patient organizations and 54.8% also from a physician; 44.7% assumed the risk of severe complications to be ≥5.0%. Not being satisfied with their medical treatment was reported by 22.2%, of whom more than 70% considered DBS a further treatment option.

Conclusions The latter numbers indicate that treating neurologists tend to overestimate the reluctance of their patients to undergo DBS. Therefore, education of patients and neurologists should be improved and give more realistic figures on the actual outcomes and frequencies of possible complications.

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Interventional magnetic resonance imaging‑guided subthalamic nucleus deep brain stimulation for Parkinson’s disease: Patient selection

iMRI STN DBS

Surg Neurol Int 02-Aug-2016;7:

Interventional magnetic resonance imaging (iMRI) guided deep brain stimulation (DBS) for Parkinson’s disease (PD) has been shown to be effective. The costs of a dedicated intraoperative MRI may be prohibitive. The procedure can also be performed in a diagnostic scanner, however this presents challenges for utilization of time when the scanner is used both as a diagnostic and an interventional unit. This report outlines our novel methodology for patient selection for implantation in a diagnostic MR scanner, as an attempt to streamline the use of resources. A retrospective review of our outcomes is also presented.

Methods: DBS candidacy evaluation included a PD questionnaire‑39. Anxiety, age, difficulties in communication and body habitus were factors that were assessed in selecting patients for this technique. Eleven patients underwent iMRI‑guided DBS implantation in the subthalamic nucleus. All patients were implanted bilaterally. Unified PD rating scale (UPDRS) part III and L‑dopa dose were compared pre‑ and post‑stimulation. A cohort of 11 DBS patients not selected for iMRI‑guided DBS were also reported for comparison.

Results: For the iMRI‑guided patients, mean “Off” UPDRS III score was 47.6 (standard deviation [SD] 8.26). Postoperative “On” medication, “On” stimulation UPDRS III was 13.6 (SD 5.23). Mean preoperative L‑dopa dose was 1060 mg (SD 474.3) and mean postoperative L‑dopa dose was 320 (SD 298.3).

Conclusion: iMRI‑guided DBS is a newly emerging technique for surgical treatment of patients with PD. We present a novel scoring system for patient selection assessing anxiety, age, ability to communicate, and body habitus to identify patients who will be benefited most from this technique.

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Validation of the Supplemented Spetzler-Martin Grading System for Brain Arteriovenous Malformations in a Multicenter Cohort of 1009 Surgical Patients

AVM

Neurosurgery 76:25–33, 2015

The supplementary grading system for brain arteriovenous malformations (AVMs) was introduced in 2010 as a tool for improving preoperative risk prediction and selecting surgical patients.

OBJECTIVE: To demonstrate in this multicenter validation study that supplemented Spetzler-Martin (SM-Supp) grades have greater predictive accuracy than Spetzler-Martin (SM) grades alone.

METHODS: Data collected from 1009 AVM patients who underwent AVM resection were used to compare the predictive powers of SM and SM-Supp grades. Patients included the original 300 University of California, San Francisco patients plus those treated thereafter (n = 117) and an additional 592 patients from 3 other centers.

RESULTS: In the combined cohort, the SM-Supp system performed better than SM system alone: area under the receiver-operating characteristics curve (AUROC) = 0.75 (95% confidence interval, 0.71-0.78) for SM-Supp and AUROC = 0.69 (95% confidence interval, 0.65-0.73) for SM (P , .001). Stratified analysis fitting models within 3 different follow-up groupings (,6 months, 6 months-2 years, and .2 years) demonstrated that the SM-Supp system performed better than SM system for both medium (AUROC = 0.71 vs 0.62; P = .003) and long (AUROC = 0.69 vs 0.58; P = .001) follow-up. Patients with SMSupp grades #6 had acceptably low surgical risks (0%-24%), with a significant increase in risk for grades .6 (39%-63%).

CONCLUSION: This study validates the predictive accuracy of the SM-Supp system in a multicenter cohort. An SM-Supp grade of 6 is a cutoff or boundary for AVM operability. Supplemented grading is currently the best method of estimating neurological outcomes after AVM surgery, and we recommend it as a starting point in the evaluation of AVM operability.

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Surgery in lumbar degenerative spondylolisthesis: indications, outcomes and complications. A systematic review

Lumbar spondylolisthesis

Eur Spine J (2014) 23:945–973

This systematic review summarises the literature on patient selection, decision-making, effectiveness and outcomes in the surgical treatment of lumbar degenerative spondylolisthesis (LDS). Introduction In daily practice, decision-making in the treatment of LDS is challenging. There is little consensus on either the precise indications or prognostic factors for any specific therapy (operative or non-operative).

Methods We searched for LDS trials published between 01.01.1990 and 16.11.2011 in Medline, Embase, Cochrane Library and Cinahl. Two independent reviewers selected studies according to the inclusion criteria. Data were then extracted by two of the authors. Quality assessment was performed using the Downs and Black list for the clinical trials/studies and AMSTAR for the reviews. Results Data synthesis: 21 papers met the inclusion criteria (2 studies comprising both a RCT and a concurrent observational analysis, 1 RCT, 6 prospective studies, 8 retrospective studies, 3 reviews, 1 review guideline). The quality of the clinical studies was on average ‘‘fair’’ [mean score 15.6 points (range 10–19) out of 24 points (Downs and Black)]. The quality of the reviews ranged from 1 to 7 out of 11 points with an average of 5 points (AMSTAR). The study outcomes could not be subject to meta-analysis due to heterogeneity of study design and variable measure used.

Conclusions Despite there being many articles describing and/or comparing different surgical options for LDS, there was insufficient evidence to draw conclusions concerning clear indications for specific types of surgical treatment, predictors of outcome or complication rates. There remains a need to establish a decision-making tool to facilitate daily clinical practice and to assure appropriate treatment for patients with LDS.

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A Supplementary Grading Scale for Selecting Patients With Brain Arteriovenous Malformations for Surgery

Neurosurgery 66:702-713, 2010. DOI: 10.1227/01.NEU.0000367555.16733.E1

Patient age, hemorrhagic presentation, nidal diffuseness, and deep perforating artery supply are important factors when selecting patients with brain arteriovenous malformations (AVMs) for surgery.

OBJECTIVE: We hypothesized that these factors outside of the Spetzler-Martin grading system could be combined into a simple, supplementary grading system that would accurately predict neurologic outcome and refine patient selection.

METHODS: A consecutive, single-surgeon series of 300 patients with AVMs treated microsurgically was analyzed in terms of change between preoperative and final postoperative modified Rankin Scale scores. Three different multivariable logistic models (full, Spetzler- Martin, and supplementary models) were constructed to test the association of combined predictor variables with the change in modified Rankin Scale score. A simplified supplementary grading system was developed from the data with points assigned according to each variable and added together for a supplementary AVM grade.

RESULTS: Predictive accuracy was highest for the full multivariable model (receiver operating characteristic curve area, 0.78), followed by the supplementary model (0.73), and least for the Spetzler-Martin model (0.66). Predictive accuracy of the simplified supplementary grade was significantly better than that of the Spetzler-Martin grade (P = .042), with receiver operating characteristic curve areas of 0.73 and 0.65, respectively.

CONCLUSION: This new AVM grading system supplements rather than replaces the wellestablished Spetzler-Martin grading system and is a better predictor of neurologic outcomes after AVM surgery. The supplementary grading scale has high predictive accuracy on its own and stratifies surgical risk more evenly. The supplementary grading system is easily applicable at the bedside, where it is intended to improve preoperative risk prediction and patient selection for surgery.

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