Vascular Non-hemor­rhagic Complications of Deep Brain Stimulation

Authors: M. Kľoc 1;  Z. Košutzká 2;  J. Šteňo 1;  P. Valkovič 2,3
Authors‘ workplace: Neurochirurgická klinika LF UK SZU a UNB, Nemocnica akad. L. Dérera, Bratislava 1;  II. neurologická klinika LF UK a UNB Nemocnica akad. L. Dérera, Bratislava 2;  Inštitút normálnej a patologickej fyziológie, Slovenská akadémia vied Bratislava 3
Published in: Cesk Slov Neurol N 2017; 80(6): 690-694
Category: Original Paper


There are different complications described in deep brain stimulation. They are associated with electrode implantation, stimulation and hardware failure. Vasospasm and ischemic infarction around electrode are less often described complications. Objective: Analysis of group of patients with clinically significant vascular non-hemorrhagic complications intraoperatively or in the temporal context with deep brain stimulation electrode implantation.

Retrospective analysis of 58 consecutive deep brain stimulation operations of subthalamic nucleus and globus pallidus internus from 2009 to  2016 with identification of the group of patients with vascular non- hemorrhagic complication. Risk factors for the development of these complications were analyzed.

We observed the case of patient with developement of subcortical ischaemia around electrode of deep brain stimulation and another four patients with acute onset of neurological symptoms such as central lesion of facial nerve, hemiparesis, transient somnolence and postoperative psychomotor passivity. Occurence of vascular non-hemorrhagic complications in the patient population was 8.6%.

Vascular non-hemorrhagic complications in addition to their presentation in the form of ischemic infarction with correlate on postopreative imaging occur probably more frequently as perioperative transient accidents without correlate on postoperative imaging. Assumed mechanism of their developement is vasospasm.

Key words:
deep brain stimulation – surgical complication – vasospasm – ischemic infarction

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Chinese summary - 摘要








观察深部脑刺激电极周围发生皮质下缺血的病例,以及另外4例神经系统症状(如面神经中枢损伤,轻偏瘫,短暂性嗜睡和术后精神运动的被动性)急性发作的患者。 患者中血管非出血性并发症的发生率为8.6%。




深部脑刺激 - 手术并发症 - 血管痉挛 - 缺血性梗塞


1. Kleiner-Fisman G, Herzog J, Fisman DN et al. Subthalamic nucleus deep brain stimulation: sum­mary and meta-analysis of outcomes. Mov Disord 2006;21(14):290– 304. doi: 10.1002/ mds.20962.

2. Soler EP, Ruiz VC. Epidemiology and risk factors of cerebral ischemia and ischemic heart dis­eases: similarities and dif­ferences. Curr Cardiol Rev 2010;6(3):138– 49. doi: 10.2174/ 157340310791658785.

3. Grif­fith RW, Humphrey DR. Long-term gliosis around chronical­ly implanted platinum electrodes in the Rhesus macaque motor cortex. Neurosci Lett 2006; 406(1-2): 81– 6. doi: 10.1016/ j.neulet.2006.07.018.

4. Haberler C, Alesch F, Mazal PR, et al. No tis­sue dama­-ge by chronic deep brain stimulation in Parkinson‘s dis­ease. Ann Neurol 2000; 48: 372– 6. doi: 10.1002/ 1531-8249(200009)48:33.3.0.CO;2-0.

5. Lefaucheur R, Der­rey S, Borden A, et al. Post-operative edema sur­round­­ing the electrode: an unusual complication of deep brain stimulation. Brain Stimul 2013;6(3):459– 60. doi: 10.1016/ j.brs.2012.05.012.

6. Sharma VD, Bona AR, Mantovani A. Cystic Lesions as a Rare Complication of Deep Brain Stimulation. Movement Disorders Clinical Practice 2015;3(1):87– 90. doi: 10.1002/ mdc3.12230.

7. Lim JY, De Sal­les AA, Bronstein J, et al. Delayed internal capsule infarctions fol­low­­ing radiofrequency pal­lidotomy. Report of three cases. J Neurosurg 1997;87(6): 955– 60. doi: 10.3171/ JNS.1997.87.6.0955.

8. Novak KE, Nenonene EK, Bernstein LP, et al. Two cases of ischemia as­sociated with subthalamic nucleus stim­ulator implantation for advanced Parkinson‘s dis­ease. Mov Disord 2006;21(9):1477– 83. doi: 10.1002/ mds.20947.

9. Alford PW, Dabiri BE, Goss JA, et al. Blast-induced pheno­­-typic switch­­ing in cerebral vasospasm. Proc Natl Acad Sci USA 2011;108(31):12705– 10. doi: 10.1073/ pnas.1105860108.

10. Pluta RM. Delayed cerebral vasospasm and nitricoxide: review, new hypothesis, and proposed treatment. Pharmacol Ther 2005;105(1):23– 56. doi: 10.1016/ j.pharmthera.2004.10.002.

11. Claas­sen J, Bernardini GL, Kreiter K, et al. Ef­fect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemor­rhage: The Fisher Scale Revisited. Stroke 2001;32(9):2012– 20. doi: 10.1161/ hs0901.095677.

12. Goldsher D, Shreiber R, Shik V, et al. Role of multisection CT angiography in the evaluation of vertebrobasilar vasospasm in patients with subarachnoid hemor­rhage. Am J Neuroradiol 2004; 25(9): 1493– 8. doi: 10.3174/ ajnr2004.25.9.1493– 8.

13. Hakim J. The penumbra: The therapeutic window. Neurology 1998;51(3):44– 6. doi: 10.1212/ wnl.51.3_Suppl_3.S44.

14. Weaver JP, Fisher M. Subarachnoid hemor­rhage: an update of pathogenesis, dia­gnosis and management. J Neurol Sci 1994;125(2):119– 31. doi: 10.1016/ 0022-510X(94)90024-8.

15. Diehl RR. Cerebral autoregulation studies in cli­ni-cal practice. Eur J Ulrasound 2002;16(1–2):31– 6. doi: 10.1016/ s0929.826600048.4.

16. Abulseoud OA, Kasasbeh A, Min HK, et al. Stimulation-induced transient nonmotor psychiatric symp­toms fol­low­­ing subthalamic deep brain stimulation in patients with Parkinson‘s dis­ease: as­sociation with clinical outcomes and neuroanatomical cor­relates. Stereotact Funct Neurosurg 2016;94(2):65– 72. doi: 10.1159/ 000445076.

17. Christoforidis GA, Spickler EM, Papaioan­nou G, et al. Lacunar infarct dur­­ing pal­lidotomy: case report. Neuroradiology 2001;43(4):321– 4. doi: 10.1007/ s002340000505.

18. Kang DW, Kim HY, Chang JW. Cerebral ischemia related to globus pal­lidus internus stimulation for cervical dystonia. Stereotact Funct Neurosurg 2011;89(4):201– 4. doi: 10.1159/ 000325655.

19. Downes AE, Pezeshkian P, Behnke E et al. Acute ischemic stroke dur­­ing deep brain stimulation surgery of globus pal­lidus internus: report of 5 cases. Oper­ative Neurosurgery 2016;12(4):383– 90. doi: 10.1227/ neu.0000000000001359.

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