How to avoid pneumocephalus in deep brain stimulation surgery? Analysis of potential risk factors in a series of 100 con
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ORIGINAL ARTICLE - FUNCTIONAL NEUROSURGERY - OTHER
How to avoid pneumocephalus in deep brain stimulation surgery? Analysis of potential risk factors in a series of 100 consecutive patients Philipp Krauss 1 & Christiaan Hendrik Bas Van Niftrik 2,3 & Giovanni Muscas 3,4 & Pierre Scheffler 2,3 & Markus Florian Oertel 2,3 & Lennart Henning Stieglitz 2,3 Received: 27 June 2020 / Accepted: 16 September 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Accuracy of lead placement is the key to success in deep brain stimulation (DBS). Precise anatomic stereotactic planning usually is based on stable perioperative anatomy. Pneumocephalus due to intraoperative CSF loss is a common procedure-related phenomenon which could lead to brain shift and targeting inaccuracy. The aim of this study was to evaluate potential risk factors of pneumocephalus in DBS surgery. Methods We performed a retrospective single-center analysis in patients undergoing bilateral DBS. We quantified the amount of pneumocephalus by postoperative CT scans and corrected the data for accompanying brain atrophy by an MRI-based score. Automated computerized segmentation algorithms from a dedicated software were used. As potential risk factors, we evaluated the impact of trephination size, the number of electrode tracks, length of surgery, intraoperative blood pressure, and brain atrophy. Results We included 100 consecutive patients that underwent awake DBS with intraoperative neurophysiological testing. Systolic and mean arterial blood pressure showed a substantial impact with an inverse correlation, indicating that lower blood pressure is associated with higher volume of pneumocephalus. Furthermore, the length of surgery was clearly correlated to pneumocephalus. Conclusion Our analysis identifies intraoperative systolic and mean arterial blood pressure as important risk factors for pneumocephalus in awake stereotactic surgery. Keywords Brain shift . Deep brain stimulation . Surgical technique . Neurosurgery . Safe surgery . Stereotactic surgery
Introduction
This article is part of the Topical Collection on Functional Neurosurgery - Other * Philipp Krauss [email protected] 1
Department of Neurosurgery, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675 Munich, Germany
2
Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
3
Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
4
Department of Neurosurgery, Careggi University Hospital Florence, Florence, Italy
Stereotactic neurosurgery offers diagnostic and therapeutic options to target highly eloquent located and deep-seated brain structures, such as the basal ganglia or the brain stem [10, 11]. Classical applications are brain biopsies or cyst and abscess drainages [28]. Further applications include placement of deep brain stimulation (DBS) leads to treat neurological and psychiatric disorders or local therapeutic strategies in neurooncology such as placement of radioactive seeds, drug delivery catheters, or
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