Evolution of Deep Brain Stimulation techniques for complication mitigation

Introduction: Complication mitigation in Deep Brain Stimulation (DBS) has been a topic matter of much discussion in the literature. Here we examine how neurosurgeons as individuals and as a field adapted the techniques they used to prevent the complications of infection, lead fracture/lead migration and suboptimal outcomes acutely and over time.

Methods: The authors performed a MEDLINE search inclusive of articles from 1987 to June 2023 including human, modeling, and animal studies written in English. Using the Rayyan platform, two reviewers (J.P. and R.M.) performed a title screen. Of the 943 articles, 252 were selected by title screen and 172 from abstract review for full text evolution. Ultimately 129 publications were evaluated. We describe initial complications and inefficiencies at the advent of DBS and speak to the changes instituted by surgeons and the field that reduced these complications.

Results: Specifically lead fractures occurred in ~10% of cases and infection in ~8% of cases. Changes in where extensions were positioned and infection control techniques resulted in incidence of < 3% for both. Symptomatic hematomas occurred in nearly all multi-center studies at ~1-2% incidence and has decreased to a rare complication due to management of blood pressure, anti-coagulations, and improved trajectory selection. Post-operative confusion has been reduced with a decrease in operative time and in amount of time off medications.

Conclusion : This scoping review adds to the literature as a guide to new neurosurgeons to understand what innovations have been trialed over time and to seasoned neurosurgeons as we embark on novel targets and neuromodulatory technologies.