Neurosurgery · 2026
Staged Versus Simultaneous Bilateral Deep Brain Stimulation: A Matched Comparison of Outcomes and Resource Utilization.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Hilvert Austin M, Sundrani Sameer, Baker Clayton R, Chao Astoria, Vanleuven Jordan, Ye Emma, Hughes Natasha, Long Isabel, Battula Sharonya, Li Rui, Shults Robert, Dawant Benoit M, Ball Tyler, Hassell Travis, Englot Dario J, Bick Sarah K
Аннотация
BACKGROUND AND OBJECTIVES: Deep brain stimulation (DBS) is a widely used treatment for movement disorders. While bilateral implantation is common, whether to implant electrodes in separate (staged) procedures or in a single (simultaneous) session remains debated.
METHODS: In this retrospective matched cohort study, 252 patients who underwent staged bilateral DBS were propensity matched to 252 who underwent simultaneous procedures (n = 504) based on age, sex, and diagnosis. Demographic, clinical, and operative data were extracted from the electronic medical record.
RESULTS: Staged patients were older (71.7 ± 6.4 vs 65.6 ± 6.9 years, P < .0001) and had lower body mass index (27.4 ± 5.4 vs 29.1 ± 6.5 kg/m 2 , P = .003). Parkinson's disease predominated in staged cases (54%) and essential tremor in simultaneous (69%) ( P < .001); dystonia was rare and similarly distributed ( P = .261). DBS targets differed: subthalamic nucleus and globus pallidus internus were more common in staged cases and ventral intermediate nucleus in simultaneous ( P < .0001). Sex, race, American Society of Anesthesiologists status classification system scores, and major comorbidities were similar ( P > .05). Staged DBS was associated with greater anesthesia utilization, operating room time, and hospital days (all P < .0001). After adjustment for covariates, there were no significant differences in intraoperative complications, postoperative complications, postoperative delirium, 30-day readmissions, medication dose reduction at 1 year, or reoperation within 5 years (odds ratios 0.81-1.44, all P > .5).
CONCLUSION: Staged and simultaneous bilateral DBS yield similar clinical outcomes; however, staged procedures require significantly greater resource utilization and subject patients to a more prolonged treatment course.
METHODS: In this retrospective matched cohort study, 252 patients who underwent staged bilateral DBS were propensity matched to 252 who underwent simultaneous procedures (n = 504) based on age, sex, and diagnosis. Demographic, clinical, and operative data were extracted from the electronic medical record.
RESULTS: Staged patients were older (71.7 ± 6.4 vs 65.6 ± 6.9 years, P < .0001) and had lower body mass index (27.4 ± 5.4 vs 29.1 ± 6.5 kg/m 2 , P = .003). Parkinson's disease predominated in staged cases (54%) and essential tremor in simultaneous (69%) ( P < .001); dystonia was rare and similarly distributed ( P = .261). DBS targets differed: subthalamic nucleus and globus pallidus internus were more common in staged cases and ventral intermediate nucleus in simultaneous ( P < .0001). Sex, race, American Society of Anesthesiologists status classification system scores, and major comorbidities were similar ( P > .05). Staged DBS was associated with greater anesthesia utilization, operating room time, and hospital days (all P < .0001). After adjustment for covariates, there were no significant differences in intraoperative complications, postoperative complications, postoperative delirium, 30-day readmissions, medication dose reduction at 1 year, or reoperation within 5 years (odds ratios 0.81-1.44, all P > .5).
CONCLUSION: Staged and simultaneous bilateral DBS yield similar clinical outcomes; however, staged procedures require significantly greater resource utilization and subject patients to a more prolonged treatment course.