Nuutti Vartiainen

The exposure of neural structures by removing the overlying bone using a high-speed drill can cause iatrogenic injury to the dura, neural tissue, and vessels. We investigated the safety and efficacy of a novel Surgify Safety Burr (SSB), attachable to existing high-speed drills. Three anesthetized living sheep underwent cranial burr hole drilling (n = 19) and hemilaminectomies (n = 14) with the SSB and standard burrs. Drilling time, dural injury, and subjective evaluation of heating and haptic feedback of each burr were assessed. Cranial burr hole drilling was done using diamond (n = 3), fluted (n = 6), and SSB (n = 10) burrs. Penetrating dura damage was observed in 33% of the diamond burr drilled holes, and in 33% of the fluted burr drilled holes, but not in the holes drilled with the SSB. Hemilaminectomies were performed with the SSB (n = 7) and diamond (n = 7) burrs without drilling-induced dura damage. Mean drilling time was not significantly different in cranial drilling (SSB, 121 ± 18s; fluted burr, 63 ± 22s; diamond burr, 165 ± 29s) nor in hemilaminectomy (SSB, 108 ± 13s; diamond burr, 95 ± 18s). Subjective evaluation of the SSB suggested efficient bone removal without heating or chattering. The SSB is a safe and effective surgical tool in cranial drilling and hemilaminectomy procedures. Safety, efficacy, and clinical benefits should be established in human studies.

BACKGROUND AND OBJECTIVES: Spinal cord stimulation (SCS) is an effective treatment for chronic pain that does not respond to conservative treatment. Nonetheless, up to 38% of all implanted SCS electrodes are explanted, and while the risks involved in the surgical implantation of SCS paddle electrodes are well documented, there is scarce information about SCS explantations and their associated complications. We aimed to document the complication rate and identify their predisposing factors in SCS paddle electrode explantations and simultaneous explantation-reimplantations. METHODS: We retrospectively reviewed the outcomes and the characteristics of all patients who underwent explantation of surgically implanted SCS paddle electrodes at the Helsinki University Hospital Department of Neurosurgery between February 2005 and October 2020. RESULTS: One hundred thirty-one explantations were performed on 106 patients. The complication rate was 18.3% (24 operations). Major complications occurred during 5 operations (3.8%). No permanent neurological deficits were recorded. Smoking predisposed patients to postoperative complications (P = .023). On average, patients who suffered complications required a day longer hospitalization (2.22 vs 2.92, P = .011). Patients who had repeated explantations (3 or more) suffered significantly more complications than patients who had only 1 or 2 operations (62.5% vs 15.4%, P = .005). CONCLUSION: Our results suggest that the explantation of the SCS paddle electrode is a relatively safe surgical procedure. Although severe complications occurred, they were successfully managed. Repeated explantations should be treated cautiously as they seem to increase the complication rate considerably.

Directional deep brain stimulation (dDBS) is preferred by patients with advanced Parkinson’s disease (PD) and by programming neurologists. However, real-life data of dDBS use is still scarce. We reviewed the clinical data of 53 PD patients with dDBS to 18 months of follow-up. Directional stimulation was favored in 70.5% of dDBS leads, and single segment activation (SSA) was used in 60% of dDBS leads. Current with SSA was significantly lower than with other stimulation types. During the 6-month follow-up, a 44% improvement in the Unified Parkinson’s Disease Rating Scale (UPDRS-III) points and a 43% decline in the levodopa equivalent daily dosage (LEDD) was observed. After 18 months of follow-up, a 35% LEDD decrease was still noted. The Hoehn and Yahr (H&Y) stages and scores on item no 30 “postural stability” in UPDRS-III remained lower throughout the follow-up compared to baseline. Additionally, dDBS relieved non-motor symptoms during the 6 months of follow-up. Patients with bilateral SSA had similar clinical outcomes to those with other stimulation types. Directional stimulation appears to effectively reduce both motor and non-motor symptoms in advanced PD with minimal adverse effects in real-life clinical care.