Reoperation for suboptimal outcomes after deep brain stimulation surgery.
Ellis TM, Foote KD, Fernandez HH, Sudhyadhom A, Rodriguez RL, Zeilman P, Jacobson CE 4th, Okun MS. (2008). Reoperation for suboptimal outcomes after deep brain stimulation surgery. , Neurosurgery. 2008 Oct;63(4):754-60; discussion 760-1.
The purpose of this article was to look at and learn from a group of patients (PD, Essential Tremor, or dystonia) that had suboptimal motoric results after their DBS surgery. They discussed that one reason for poor results after surgery is suboptimally placed leads (even 2-3mm off target has been shown to affect results). These authors looked at a group of patients that underwent reoperation with revision or replacement of the leads. It should be noted that the group of patients from this study had their original surgery at a variety of sites, including that of the authors, which suggests that lead difficulties are possible regardless of where the surgery takes place or how careful the team is in placing the leads. The authors suggested various precautions and techniques for movement disorder multidisciplinary teams to minimize such lead problems. As DBS is a relatively new surgery for movement disorders, there will continue to be different surgical techniques used and implantation sites completed on various patients. Researchers and clinicians need to continue to monitor and report their data to each other in order to come up with the best practice to successfully treat patients with movement disorders.
After reoperation the majority of the patients in this study had improvement in motor complaints and multiple areas of quality of life. As can be seen with any DBS surgery, there were some adverse events noted with reoperation for 3 of the patients (infection, lead fracture, and wound closure difficulty due to thin skin). The authors concluded that reoperation showed benefit for these patients. They also discussed the strong need to have multidisciplinary teams create policies and guidelines for selection of patients that are good candidates for reoperation so that the subsequent surgery can be successful.