Minimising the rate of vascular complications in Deep Brain Stimulation surgery for the management of Parkinson’s disease: a single-centre 600-patient case series

Abstract

Objectives Deep Brain Stimulation (DBS) is an effective, yet underused therapy for people living with Parkinson’s disease (PD) in whom tremor, motor fluctuations and/or dyskinesia are not satisfactorily controlled by oral medical therapy. Fear of vascular complications related to the operative procedure remains a strong reason for both the referrer and patient reluctance. We review the incidence of vascular complications in the first 600 patients with Parkinson’s disease treated at our centre by a single neurologist/neurosurgical team.Methods Surgical data routinely collected for patients who underwent DBS implantation for the management of PD between the years 2001–2023 was retrospectively reviewed. Incidences of vascular complication were analysed in detail, examining causal factors.Results Including reimplantations, 600 consecutive DBS patients underwent implantation with 1222 DBS electrodes. Three patients (0.50%) experienced vascular complications.Conclusion This vascular complication rate is at the low end of that reported in the literature. Risk mitigation strategies discussed include a consistent neurosurgical team, dual methodology target and trajectory planning, control of cerebrospinal fluid egress during the procedure, use of a specialised microelectrode recording (MER)/macrostimulation electrode without an introducing brain cannula and low number of MER passes. A reduced vascular complication rate may improve the acceptability of DBS therapy for both patients and referrers.