Hemorrhagic and repositioning risk factors related to intraoperative multitrack microrecording on a large series of patients treated for deep brain stimulation

Background: Deep brain stimulation (DBS) is a commonly performed surgical technique used to treat various movement disorders. Despite DBS being nonablative and minimally invasive, numerous complications and side effects have been recorded, the most critical of which are intracranial ischaemic/hemorrhagic events. Methods: We analyzed this complication in relation to simultaneous multitrack microrecording (MER) as observed in our experience. The possible contribution of MER to the precision of the DBS procedure was also evaluated. From October 1996 to January 2010, 532 consecutive procedures were performed at the Unit of Functional Neurosurgery, Division of Neurosurgery IRCCS Galeazzi in Milan, and at the Istituto Besta IRCCS in Milan by 2 of the Authors (D.S. and M.S.), on a total number of 272 patients. Findings: Ischaemic/hemorrhagic complications were documented in 9 patients (1.6%), and 5 of them presented with a neurological syndrome. Overall mortality was 3 patients (1.1%), and was correlated with intracranial hemorrhage in 1 patient. Repositioning of incorrectly positioned electrodes was deemed necessary in 26 procedures (4.9%) on 23 patients (8.4%). Conclusions: Although no consistent association was documented between the use of simultaneous intraoperative multitrack MER and hemorrhage, a statistically significant association was recorded between an incorrect positioning of the definitive leads, as reported in the postoperative magnetic resonance imaging controls or at the intraoperative computed tomographic (CT) scans, and the lack of intraoperative MER. DBS proves to be a safe and effective procedure even for novel indications. In our experience, no association was found between hemorrhagic risk and simultaneous multitrack MER.