目的:脑深部电刺激(DBS)是治疗药物难治性运动障碍和其他神经系统疾病的有效方法。为了全面表征患病率,地点,检测的定时,临床效果,与DBS相关的颅内出血(ICH)的危险因素,作者对已发表的文献进行了系统回顾.
方法:PubMed,EMBASE,和WebofScience使用两个概念进行搜索:脑出血和脑刺激,带有英语过滤器,人类研究,和出版日期1980-2023年。纳入标准是对任何人类神经系统疾病使用DBS干预,根据位置和临床效果记录出血并发症。非DBS干预研究,没有出血结果的文件,患者队列≤10,儿科患者被排除.使用循证医学中心的证据水平评估偏倚的风险。作者对ICH患病率进行了比例荟萃分析。
结果:共63项研究,有13056名患者,符合纳入标准。ICH的患病率为2.9%(固定效应模型,95%CI2.62%-3.2%)和1.6%(随机效应模型,95%CI1.34%-1.87%)每条DBS导线,49.6%有症状。ICH率没有随时间变化。ICH最常见于DBS导线周围,16%处于切入点,沿轨道31%,7%的目标。与没有MER的DBS相比,DBS期间的微电极记录(MER)与ICH率增加有关(3.5±2.2vs2.1±1.4;p[T≤t]1-tail=0.038)。其他报告的ICH危险因素包括术中收缩压>140mmHg,sulcalDBS轨迹,和多个微电极插入。术后24小时检测到60%的ICH,术中检测到27%。DBS全因死亡率为0.4%,ICH占死亡人数的22%。单外科医生DBS的经验表明,每条导线的ICH率与每年植入的导线数量之间存在弱的负相关(r=-0.27,p=0.2189)。
结论:本研究提供了III级证据,表明DBS期间的MER是ICH的危险因素。其他危险因素包括术中收缩压>140mmHg,沟轨迹,和多个微电极插入。避免这些危险因素可能会降低ICH的发生率。
OBJECTIVE: Deep brain stimulation (DBS) is an effective treatment for medically refractory movement disorders and other neurological conditions. To comprehensively characterize the prevalence, locations, timing of detection, clinical effects, and risk factors of DBS-related intracranial hemorrhage (ICH), the authors performed a systematic
review of the published literature.
METHODS: PubMed, EMBASE, and Web of Science were searched using 2 concepts: cerebral hemorrhage and brain stimulation, with filters for English, human studies, and publication dates 1980-2023. The inclusion criteria were the use of DBS intervention for any human neurological condition, with documentation of hemorrhagic complications by location and clinical effect. Studies with non-DBS interventions, no documentation of hemorrhage outcome, patient cohorts of ≤ 10, and pediatric patients were excluded. The risk of bias was assessed using Centre for Evidence-Based Medicine Levels of Evidence. The authors performed proportional meta-analysis for ICH prevalence.
RESULTS: A total of 63 studies, with 13,056 patients, met the inclusion criteria. The prevalence of ICH was 2.9% (fixed-effects model, 95% CI 2.62%-3.2%) per patient and 1.6% (random-effects model, 95% CI 1.34%-1.87%) per DBS lead, with 49.6% being symptomatic. The ICH rates did not change with time. ICH most commonly occurred around the DBS lead, with 16% at the entry point, 31% along the track, and 7% at the target. Microelectrode recording (MER) during DBS was associated with increased ICH rate compared to DBS without MER (3.5 ± 2.2 vs 2.1 ± 1.4; p[T ≤ t] 1-tail = 0.038). Other reported ICH risk factors include intraoperative systolic blood pressure > 140 mm Hg, sulcal DBS trajectories, and multiple microelectrode insertions. Sixty percent of ICH was detected at 24 hours postoperatively and 27% intraoperatively. The all-cause mortality rate of DBS was 0.4%, with ICH accounting for 22% of deaths. Single-surgeon DBS experience showed a weak inverse correlation (r = -0.27, p = 0.2189) between the rate of ICH per lead and the number of leads implanted per year.
CONCLUSIONS: This study provides level III evidence that MER during DBS is a risk factor for ICH. Other risk factors include intraoperative systolic blood pressure > 140 mm Hg, sulcal trajectories, and multiple microelectrode insertions. Avoidance of these risk factors may decrease the rate of ICH.