Neue Daten zur Sicherheit der Operation bei der tiefen Hirnstimulation

Zusammenfassung

Operationen zur tiefen Hirnstimulation (THS) beinhalten die stereotaktische Implantation von Hirnelektroden in subkortikale Zielstrukturen des Zentralnervensystems sowie peripher die subkutane Implantation von Impulsgebern (IPG) und Verbindungskabeln. Der Erfahrungszeitraum über den Einsatz der THS beträgt mittlerweile 10–15 Jahre, sodass für eine große Zahl von Patienten Nebenwirkungen bzw. Komplikationen dokumentiert wurden, die im Zusammenhang mit diesen Eingriffen aufgetreten sind. Neueren Daten zufolge ist der operative Teil der THS vergleichsweise sicher und mit geringem Risiko behaftet. Die Rate schwerer Komplikationen als unmittelbare Folge der Operation (z. B. intrakranielle Blutung) kann durch richtiges Patientenmanagement, durch einen hohen technischen Aufwand bei der präoperativen, computerassistierten und bildgestützten Planung dieser Eingriffe sowie eine geeignete Operationstechnik auf einen Bereich von 1–3 % reduziert werden. Auch kann das Risiko für viele der vergleichsweise harmlosen implantatbedingten Nebenwirkungen durch Erfahrung des Operateurs und bestimmte operative Maßnahmen signifikant reduziert werden.

Abstract

Surgery for deep brain stimulation (DBS) includes the stereotactically guided implantation of brain electrodes in subcortical target areas of the central nervous system and the subcutaneous implantation of impulse generators (IPG) and connection cables. To date we have more than 10 years practical experiences with these interventions and adverse events or complications are documented for a reasonably large number of patients. According to recently published data, the risk for severe complications resulting directly from the surgery performed (e. g., intracranial haemorrhage) is comparatively low (range: 1–3 %) if attempts are made to perform preoperative computer-assisted and image-guided treatment planning on a high technical standard and if appropriate patient management and surgical techniques are applied. Also the frequency of many of the hardware-related complications (e. g., infection) which are considered to be relatively harmless can be significantly reduced with increasing experience of the surgeons and by the introduction of standardised operation procedures.

Schlüsselwörter

Stereotaxie - tiefe Hirnstimulation - Komplikationen

Key words

stereotaxy - deep brain stimulation - complications

Literatur

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