Hardware-related complications and their management...Hardware-related complications and their...
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Hardware-related complications and their management Yasin Temel Maastricht University Medical Center, Maastricht Radboud University Medical Center, Nijmegen Interuniversity-DBS Center The Netherlands
Transcript of Hardware-related complications and their management...Hardware-related complications and their...
Hardware-related complicationsand their management
Yasin TemelMaastricht University Medical Center, Maastricht
Radboud University Medical Center, NijmegenInteruniversity-DBS Center
The Netherlands
Hariz classification, 2002
• Complications
– Surgery
– Hardware
– Target
Hardware/Surgery
• Perioperative • Postoperative
Perioperative complications
• Retrospective analysis– Alptekin et al, in press
– Collected data from 5 centers
– Limitations• Can be non-exhaustive• Relying on documented data
• Frame-related• Fusion-related• Positioning-related
• Electrophysiology• Test stimulation• Final electrode implantation• Electrode verification
• Frame-mounting difficulties
– Local anesthesia• Dystonia• Tics• Dyskinesia
– General anesthesia
Tilted frame
Alptekin et al, in prep
Alptekin et al, in press
Positioning issues
CT/MRI fusion
Alptekin et al, in press
Frontal sinus/Fusion issues
Alptekin et al, in press
Maintenance issues
• Check the accuracy of your frames regularly
– Before each surgery
– Each 3 surgeries
• PHANTOM
• LOCALIZER PLATFORM
• Infections
– 1-22%
– Low-grade
– Cranial infections rare
• Hemorrhages
– 0-2%
– Asymptomatic
– Risk factors
Hemorrhages
Tonge et al, 2015
Tonge et al, 2015
- Single vs double-dose gadolinium
- The overall calculated risk of an ICH was 0.31% per recording electrode and 0.24%
- Zrinzo et al, 2012:
Case series and literature review• Total incidence of hemorrhage in own series was 0.9%:
- asymptomatic in 0.5%. - symptomatic in 0.5%.
• Weighted means calculated from the literature review: - overall incidence of hemorrhage in functional neurosurgery is 5.0%:.
asymptomatic hemorrhage in 1.9% symptomatic hemorrhage in 2.1% hemorrhage resulting in permanent deficit or death in 1.1%
Risk factors: hypertension and age, use of MER, and number of MER penetrations, as well as sulcal or ventricular involvement by the trajectory
Zrinzo et al, 2012
Other complications
– “Traction” of cables– Lead fracture– Malfunction of the IPG– Rotation of the IPG in
the pocket
• Lead migration
– 4-5% (Boviatsis et al, 2010)
– Depending on the lead fixation technique
Team• Lab: M. Aldehri, M. Alahmari, F.
Alasami, J. Habets, S. Hescham, G. Hoogland, B. Isaacs, A. Jahanshahi, M. Janssen, P. Janssen, A. Mulders, S. Pol, M. Roet, F. Schaper, G. Van Zwieten.
• Clinics: L. Ackermans, T. Bouwens, A. Duits, R. Esselink , F. Gubler, P. Kubben, M. Kuijf, A. Leentjens, M. Oosterloo, R. Rouhl, K. Schruers, A. Smeets, V. van Kranen-Mastenbroek, J. Vermeulen, S. Vinke.
