Radiofrequency Ablation for Movement Disorders: Risk Factors for Intracerebral Hemorrhage, a Retrospective Analysis

Abstract

Background: One of the greatest concerns associated with radiofrequency ablation is intracerebral hemorrhage (ICH). However, the majority of previous studies have mainly evaluated Parkinson disease patients with ablation of the globus pallidus internus (GPi).

Objective: To investigate the hemorrhagic risk associated with radiofrequency ablation using ventro-oral (Vo) nucleus, ventral intermediate (Vim) nucleus, GPi, and pallidothalamic tract.

Methods: Radiofrequency ablations for movement disorders from 2012 to 2019 at our institution were retrospectively analyzed. Multivariate analyses were performed to evaluate associations between potential risk factors and ICH.

Results: A total of 558 patients underwent 721 stereotactic radiofrequency ablations for movement disorders. Among 558 patients, 356 had dystonia, 111 had essential tremor, and 51 had Parkinson disease. Among 721 procedures, the stereotactic targets used in this study were as follows: Vo: 230; Vim: 199; GPi: 172; pallidothalamic tract: 102; Vim/Vo: 18. ICH occurred in 37 patients (5.1%, 33 with dystonia and 4 with essential tremor). Symptomatic ICH developed in 3 Vo nuclei (1.3%), 3 Vim nuclei (1.5%), and 2 GPi (1.2%). Hypertension (odds ratio = 2.69, P = .0013), higher number of lesions (odds ratio = 1.23, P = .0221), and younger age (odds ratio = 1.04, P = .0055) were significant risk factors for ICH associated with radiofrequency ablation.

Conclusion: The present study revealed that younger age, higher number of lesions, and history of hypertension were independent risk factors for ICH associated with stereotactic radiofrequency ablation.

Keywords: Intracerebral hemorrhage; Radiofrequency ablation; Stereotactic surgery.