Safety of the transventricular approach to deep brain stimulation: A retrospective review

Abstract

Background: Anatomically, deep brain stimulation (DBS) targets such as the ventral intermediate and subthalamic nucleus are positioned such that the long axis of the nucleus is often most accessible through a transventricular trajectory. We hypothesize that using this trajectory does not place patients at increased risk of neurologic complications.

Methods: A series of 206 patients at a single institution between 2000 and 2017 were reviewed. All patients had a confirmed transventricular trajectory and their clinical course was reviewed to assess neurologic complication rates in the postoperative period.

Results: The average length of hospital stay was 2.4 days. The most common neurologic complication was altered mental status in 1.2% of cases (four patients). This was followed by seizure in 0.6% of cases (two patients). No patients had ischemic stroke or postoperative hemiparesis. There were two mortalities in this series, one with lobar hemorrhage contralateral from the surgical site and one with a thalamic hemorrhage. There was only one confirmed intraventricular hemorrhage postoperatively; however, this was clinically asymptomatic.

Conclusion: Although the total incidence of intraventricular or intracerebral hemorrhage cannot be reliably assessed from this data set, the low incidence of neurologic complications challenges the notion that DBS electrode trajectories that transgress the ventricle significantly increase the risk of complications.

Keywords: Deep brain stimulation; Functional; Movement disorders; Parkinson’s disease; Transventricular; Tremor.

Figure 1:

Ventral intermediate (VIM) trajectory. T1 magnetic resonance imaging showing trajectory of the left VIM electrode. Top left – sagittal view of electrode at target, top middle – coronal view of electrode entering left lateral ventricle, top right – coronal view of electrode exiting left lateral ventricle, bottom right – axial view of electrode at target.

Figure 2:

Subthalamic nucleus (STN) trajectory. T1 magnetic resonance imaging showing trajectory of the right STN electrode. Top left – sagittal view of electrode at target, top middle – coronal view with electrode entering right lateral ventricle, top right – electrode exiting ventricle, bottom middle – axial view of electrode at target.