• Bouwens van der VlisTim A MTAMDepartment of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands. Electronic address: tim.bouwens@mumc.nl., Mégan M G H van de Veerdonk, Linda Ackermans, LeentjensAlbert F GAFGDepartment of Psychiatry, Maastricht University Medical Center, Maastricht, The Netherlands., JanssenMarcus L FMLFSchool for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands., Mark L Kuijf, SchruersKoen R JKRJDepartment of Psychiatry, Maastricht University Medical Center, Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Mondriaan Mental Health Center, Maastricht, The , Annelien Duits, Felix Gubler, Pieter Kubben, and Yasin Temel.
• Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands. Electronic address: tim.bouwens@mumc.nl.
• Neuromodulation. 2022 Feb 1; 25 (2): 296-304.

IntroductionAlthough deep brain stimulation (DBS) is effective for treating a number of neurological and psychiatric indications, surgical and hardware-related adverse events (AEs) can occur that affect quality of life. This study aimed to give an overview of the nature and frequency of those AEs in our center and to describe the way they were managed. Furthermore, an attempt was made at identifying possible risk factors for AEs to inform possible future preventive measures.Materials And MethodsPatients undergoing DBS-related procedures between January 2011 and July 2020 were retrospectively analyzed to inventory AEs. The mean follow-up time was 43 ± 31 months. Univariate logistic regression analysis was used to assess the predictive value of selected demographic and clinical variables.ResultsFrom January 2011 to July 2020, 508 DBS-related procedures were performed including 201 implantations of brain electrodes in 200 patients and 307 implantable pulse generator (IPG) replacements in 142 patients. Surgical or hardware-related AEs following initial implantation affected 40 of 200 patients (20%) and resolved without permanent sequelae in all instances. The most frequent AEs were surgical site infections (SSIs) (9.95%, 20/201) and wire tethering (2.49%, 5/201), followed by hardware failure (1.99%, 4/201), skin erosion (1.0%, 2/201), pain (0.5%, 1/201), lead migration (0.52%, 2/386 electrode sites), and hematoma (0.52%, 2/386 electrode sites). The overall rate of AEs for IPG replacement was 5.6% (17/305). No surgical, ie, staged or nonstaged, electrode fixation, or patient-related risk factors were identified for SSI or wire tethering.ConclusionsMajor AEs including intracranial surgery-related AEs or AEs requiring surgical removal or revision of hardware are rare. In particular, aggressive treatment is required in SSIs involving multiple sites or when Staphylococcus aureus is identified. For future benchmarking, the development of a uniform reporting system for surgical and hardware-related AEs in DBS surgery would be useful.Copyright © 2021. Published by Elsevier Inc.

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