目的:报告接受微电极记录(MER)引导的深部脑刺激(DBS)患者有症状和无症状脑出血(ICH)的发生率,并进一步分析潜在的危险因素,两者都是患者固有的,与病理和手术技术有关。
方法:我们进行了一项回顾性观察研究。在2010年1月至2020年12月期间,在一个医院中心的277名患者中完成了297项DBS程序。所有手术均在MER指导下进行。我们分析了有症状和无症状ICH的发生率及其与年龄的相关性,性别,诊断,高血压和围手术期高血压,糖尿病,血脂异常,抗血小板药物,解剖目标,和MER轨迹的数量。
结果:277例患者共植入585个电极。观察到16例ICH,其中6人有症状,10人无症状,都没有出现永久性神经缺陷。出血的位置在皮质和皮质下计划之间有所不同,始终与电极的轨迹或最终位置有关。每次导线植入的症状性ICH发生率为1%,CT扫描显示无症状ICH的患者增加了1.7%.男性患者或高血压患者发生ICH的可能性分别为2.7和2.2倍,分别。然而,这些特征均未显示与ICH的发生有统计学意义的关联,以及年龄,诊断,糖尿病,血脂异常,抗血小板药物,解剖目标,MER轨迹数和围手术期高血压。
结论:MER引导的DBS是一种安全的技术,在我们的研究中,ICH的发病率低,没有永久性缺陷。高血压和男性似乎是该手术中ICH发展的危险因素。然而,没有发现该并发症发生的有统计学意义的因素.
Report the incidence of symptomatic and asymptomatic intracerebral hemorrhage (ICH) in patients submitted to deep brain stimulation (DBS) guided with microelectrode recording (MER) with further analysis of potential risk factors, both inherent to the patient and related to the pathology and surgical technique.
We performed a retrospective observational study. 297 DBS procedures were concluded in 277 patients in a single hospital centre between January 2010 and December 2020. All surgeries were guided with MER. We analysed the incidence of symptomatic and asymptomatic ICH and its correlation to age, sex, diagnosis, hypertension and perioperative hypertension, diabetes, dyslipidaemia, antiplatelet drugs, anatomic target, and number of MER trajectories.
There were a total of 585 electrodes implanted in 277 patients. 16 ICH were observed, of which 6 were symptomatic and 10 asymptomatic, none of which incurred in permanent neurological deficit. The location of the hemorrhage varied between cortical and subcortical plans, always in relation with the trajectory or the final position of the electrode. The incidence of symptomatic ICH per lead-implantation was 1%, and the CT-scan demonstrated asymptomatic ICH in 1.7% more patients. Male patients or with hypertension are 2.7 and 2.2 times more likely to develop ICH, respectively. However, none of these characteristics has been shown to have a statistically significant association with the occurrence of ICH, as well as age, diagnosis, diabetes, dyslipidaemia, antiplatelet drugs, anatomic target, number of MER trajectories and perioperative hypertension.
MER-guided DBS is a safe technique, with low incidence of ICH and no permanent deficits in our study. Hypertension and male sex seem to be risk factors for the development of ICH in this surgery. Nevertheless, no statistically significant factors were found for the occurrence of this complication.