TY - JOUR
T1 - Craniotomy for subdural hematoma after deep brain stimulation surgery
T2 - Outcomes and satisfaction in a case series of two patients
AU - Mao, Gordon
AU - Gigliotti, Michael J.
AU - Angle, Cindy
AU - Whiting, Donald
AU - Tomycz, Nestor
N1 - Publisher Copyright:
© 2018
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2018/7
Y1 - 2018/7
N2 - Objective: To determine whether salvage of DBS hardware is beneficial for Parkinson's Disease (PD) patients by looking at follow-up patient's outcomes and satisfaction after their craniotomy operation. Patients and methods: This was a retrospective review of a prospective, single-center deep brain stimulation (DBS) database between 2002–2016 identifying patients with PD who developed subdural hematomas (SDH) due to trauma after their DBS surgery. Of the 636 DBS cases that were performed, 3 PD-DBS patients with significant traumatic SDH managed via craniotomy were identified. Out of these 3 patients, only 2 permitted outcome analysis. At follow-up, functional and neurologic status, UPDRS motor score, and overall satisfaction with DBS were assessed. Results: Two patients were followed for a period of 10 and 9 months. At last follow-up, the DBS settings in patient 1 increased from a stimulation amplitude of 3.5 V to 4.5 V on the right and 3.3 V to 6.0 V on the left with an increase in the pulse width as well (70–80 ms and 80–140 ms on the right and left, respectively). Stimulation frequency remained 160 Hz on the right while increasing from 145 to 160 Hz on the left. Patient 2 experienced an increase in stimulation amplitude from 4.5 V to 4.8 V on the right while remaining the same on the left. Pulse width increased from 60 to 70 ms bilaterally as well as the frequency (160–185 Hz bilaterally). Despite craniotomy, both patients experienced substantial improvement in UPDRS motor score with DBS at last follow-up (53–25 and 20–17 for patient 1 and 2, respectively). At last follow-up, CT imaging provided evidence of complete SDH resolution with no persistent hemorrhage, mass effect or any obvious lead displacement. Patients expressed satisfaction with DBS and affirmed that they would undergo surgery again for the same outcome. Conclusion: Patients with PD are at higher risk for falls and may experience an increased risk of falling associated with SDH in the post-operative period after DBS implantation. Despite brain shift from SDH potentially distorting DBS leads, DBS implants still provided significant benefit in patients requiring craniotomy for SDH and patient satisfaction with DBS remained high. Salvage of DBS hardware is recommended since significant symptomatic improvement with DBS programming may still be attainable even in the setting of emergent craniotomy for SDH.
AB - Objective: To determine whether salvage of DBS hardware is beneficial for Parkinson's Disease (PD) patients by looking at follow-up patient's outcomes and satisfaction after their craniotomy operation. Patients and methods: This was a retrospective review of a prospective, single-center deep brain stimulation (DBS) database between 2002–2016 identifying patients with PD who developed subdural hematomas (SDH) due to trauma after their DBS surgery. Of the 636 DBS cases that were performed, 3 PD-DBS patients with significant traumatic SDH managed via craniotomy were identified. Out of these 3 patients, only 2 permitted outcome analysis. At follow-up, functional and neurologic status, UPDRS motor score, and overall satisfaction with DBS were assessed. Results: Two patients were followed for a period of 10 and 9 months. At last follow-up, the DBS settings in patient 1 increased from a stimulation amplitude of 3.5 V to 4.5 V on the right and 3.3 V to 6.0 V on the left with an increase in the pulse width as well (70–80 ms and 80–140 ms on the right and left, respectively). Stimulation frequency remained 160 Hz on the right while increasing from 145 to 160 Hz on the left. Patient 2 experienced an increase in stimulation amplitude from 4.5 V to 4.8 V on the right while remaining the same on the left. Pulse width increased from 60 to 70 ms bilaterally as well as the frequency (160–185 Hz bilaterally). Despite craniotomy, both patients experienced substantial improvement in UPDRS motor score with DBS at last follow-up (53–25 and 20–17 for patient 1 and 2, respectively). At last follow-up, CT imaging provided evidence of complete SDH resolution with no persistent hemorrhage, mass effect or any obvious lead displacement. Patients expressed satisfaction with DBS and affirmed that they would undergo surgery again for the same outcome. Conclusion: Patients with PD are at higher risk for falls and may experience an increased risk of falling associated with SDH in the post-operative period after DBS implantation. Despite brain shift from SDH potentially distorting DBS leads, DBS implants still provided significant benefit in patients requiring craniotomy for SDH and patient satisfaction with DBS remained high. Salvage of DBS hardware is recommended since significant symptomatic improvement with DBS programming may still be attainable even in the setting of emergent craniotomy for SDH.
KW - Craniotomy
KW - DBS
KW - Parkinson's disease
KW - Subdural hematoma
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U2 - 10.1016/j.clineuro.2018.04.022
DO - 10.1016/j.clineuro.2018.04.022
M3 - Article
C2 - 29729543
AN - SCOPUS:85046461065
SN - 0303-8467
VL - 170
SP - 53
EP - 57
JO - Clinical Neurology and Neurosurgery
JF - Clinical Neurology and Neurosurgery
ER -