Introduction: Since 2007 we have offered Deep Brain Stimulator (DBS) placement in select pediatric movement disorder patients at Cook Children’s Hospital. Over time we have modified the surgical approach to help increase efficacy and minimize morbidity.
Methods: An IRB approved retrospective review was performed on our first 100 DBS patients. All patients enrolled for DBS surgery at Cook Children’s Hospital undergo a rigorous consent process approved by our institutional review board in accordance with the current United States FDA Humanitarian Device Exemption status of this device for dystonia.
Results: The average age at implantation was 13.8 years. Diagnosis was primary dystonia in 34 patients, secondary dystonia in 61, and tremor in 5. Implant site was globus pallidus internus (GPi) in 92, ventral intermediate nucleus (VIM) of thalamus in 4, subthalamic nucleus (STN) in 3, and one combo of GPi / STN. Complications were common with 12 infections in 9 patients, 8 strokes or hemorrhages in 8 patients, 15 electrode revisions (4 fractured, 11 repositioned) and 8 extension wire revisions due to malfunction / fractures. The first 80 patients were done awake with microelectrode recordings, but have transitioned to asleep surgery for the last 20 patients with no change in outcomes
Conclusions: Over the last 9 years, we have modified our surgical approach to minimize complications (more lateral trajectory to decrease strokes / hemorrhage, two stage placement to decrease infection, and asleep surgery to increase comfort). Although fraught with complications, pediatric DBS affords another viable treatment option that movement disorder teams can offer to these challenging patients.
Patient Care: To help minimize complications in pediatric DBS surgery.
Learning Objectives: To understand how to minimize complications in pediatric DBS surgery.