ArticleNeurosurgical review2026
Hemorrhagic complications in deep brain stimulation: analysis of non-surgical risk factors in a cohort of 683 patients.
Article in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Deep brain stimulation (DBS) is an established neurosurgical therapy for movement disorders, neuropsychiatric conditions, and drug-resistant epilepsy. Intracranial hemorrhage (ICH) remains among the most severe complications of DBS, with limited data on its risk factors. This study aims to assess the incidence of ICH and evaluate associated non-surgical and selected surgical risk factors in a large, single-center cohort. We retrospectively analyzed 683 patients (1227 DBS electrodes implanted) treated at a single medical center between November 2008 and April 2025. Data on demographics, diagnoses, comorbidities, and surgical techniques were collected and analyzed using both statistical and descriptive methods to identify predictors of ICH. ICH were classified as symptomatic (transient or permanent) or asymptomatic based on clinical outcomes. ICH occurred in 34 patients (4.98%), with 40 hemorrhagic events in total (3.26% per lead). Permanent neurological deficits occurred in 6 patients (0.9%). Antithrombotic therapy was significantly associated with overall ICH in both univariate and multivariate analyses (OR = 4.14, p = 0.002; OR = 4.06, p = 0.003) and was also associated with symptomatic ICH. The use of microelectrode recording (MER) was significantly associated with symptomatic ICH. No associations were found for sex, age, hypertension, diagnosis, or surgical variables other than MER. Subthalamic nucleus targeting was observed in the majority of patients with permanent deficits. DBS remains a safe procedure with a low risk of permanent ICH-related morbidity. Antithrombotic therapy and MER are modifiable risk factors. Continued refinement in perioperative planning is essential to further minimize ICH risk.
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