BACKGROUND:Cerebrovascular accident (CVA) is a potentially devastating complication of deep brain stimulation (DBS) surgery. Although there are substantial data reporting the incidence and cause of hemorrhagic CVA, reports of acute ischemic infarctions during DBS implantation surgery are rare.OBJECTIVE:To present a series of 5 patients who experienced clinically significant ischemic CVA during microelectrode-guided globus pallidus internus (GPi) DBS, and evaluate the potential risk factors and mechanisms.METHODS:A retrospective analysis of GPi DBS surgeries performed between June 2010 and February 2015 at UCLA Medical Center and June 2010 and February 2014 at Cedars-Sinai Medical Centers was performed to identify stroke risk factors. Statistical analysis was performed, comparing the stroke group with all patients undergoing GPi DBS.RESULTS:All 5 patients developed acute onset of lethargy, dysarthria, and contralateral facial and/or hemibody weakness intraoperatively. Computed tomographic scans in all cases were negative for hemorrhage. Magnetic resonance images obtained in 3 patients revealed infarction in the posterior limb of the internal capsule. During the time period analyzed, a total of 234 GPi leads were placed in 129 patients, yielding a 2.14% rate of ischemic stroke per lead. No statistically significant risk factors were identified in the stroke group. Given the variability of symptom onset during surgery, the mechanism is not clear, but it could be related to compression, compromise, or vasospasm of lenticulostriate arteries and/or anterior choroidal branches near the GPi target.CONCLUSION:Ischemic stroke in GPi DBS is a significant complication for clinicians to be aware of and discuss with their patients preoperatively.
Operative Neurosurgery – Oxford University Press
Published: Dec 1, 2016
It’s your single place to instantly
discover and read the research
that matters to you.
Enjoy affordable access to
over 12 million articles from more than
10,000 peer-reviewed journals.
All for just $49/month
Read as many articles as you need. Full articles with original layout, charts and figures. Read online, from anywhere.
Keep up with your field with Personalized Recommendations and Follow Journals to get automatic updates.
It’s easy to organize your research with our built-in tools.
Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.
All the latest content is available, no embargo periods.
“Hi guys, I cannot tell you how much I love this resource. Incredible. I really believe you've hit the nail on the head with this site in regards to solving the research-purchase issue.”Daniel C.
“Whoa! It’s like Spotify but for academic articles.”@Phil_Robichaud
“I must say, @deepdyve is a fabulous solution to the independent researcher's problem of #access to #information.”@deepthiw
“My last article couldn't be possible without the platform @deepdyve that makes journal papers cheaper.”@JoseServera