Comparative Analysis of Hemorrhagic Complications in Deep Brain Stimulation: Microelectrode Recording versus Macrostimulation-Does the Technique Matter?

Background: Hemorrhage is a dangerous complication of deep brain stimulation (DBS) surgery, but a comprehensive explanation of the associated risk factors remains inconclusive, particularly application of microelectrode recording (MER) compared with macrostimulation (non-MER)-based DBS procedures. We conducted a comparative analysis of MER and macrostimulation techniques, evaluating the impact of brain penetrations by microelectrode guiding cannulas on the occurrence of intracranial hemorrhagic events.

Methods: This retrospective study included all DBS procedures (MER-based and non-MER-based) performed at a single medical center from November 2008 to June 2023. Patients underwent comprehensive preoperative and postoperative evaluations, including postoperative computed tomography to assess lead placement and intracranial bleeding, categorized as symptomatic or asymptomatic. Statistical analyses were conducted to ascertain the correlation between different surgical techniques and the risk of hemorrhagic complications.

Results: In a cohort of 618 patients, 1096 electrodes were implanted during 672 consecutive DBS procedures. There were 21 asymptomatic and 6 symptomatic intracranial hemorrhages (ICHs), including 1 death. The bleeding rate was 4.37% per patient and 2.92% per electrode. Patients who developed hematomas were more prevalent in the MER group (25 cases) compared with the non-MER group (2 cases). The MER group had a higher mean number of brain penetrations by guiding cannulas.

Conclusions: DBS procedures are generally safe, with only 0.97% resulting in long-term or permanent deficits. All symptomatic ICH occurred in MER-based procedures, whereas macrostimulation was associated with only 2 asymptomatic ICH cases. The higher number of brain penetrations in MER correlates with higher bleeding rates.