Masataka Tanaka1, Naoki Tani2, Tomoyuki Maruo3, Satoru Oshino1, Koichi Hosomi4, Youichi Saitoh4, Haruhiko Kishima1. 1. Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan. 2. Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan. Electronic address: n-tani@nsurg.med.osaka-u.ac.jp. 3. Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan; Department of Neurosurgery, Otemae Hospital, Osaka, Japan. 4. Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan.
Abstract
OBJECTIVE: The aim of this study was to investigate the incidence of and risk factors for postoperative delirium (POD) after deep brain stimulation (DBS) surgery in patients with Parkinson disease. METHODS: We analyzed the preoperative T1-weighted magnetic resonance imaging data of 71 patients with Parkinson disease who underwent DBS surgery. Multiple regression analysis was performed with age, l-dopa equivalent daily dose, laterality of the surgery, target regions, number of electrode trajectories tried, gray matter volume, and white matter (WM) volume as explanatory variables and the duration (number of days) of POD as the response variable. In addition, regional brain atrophy associated with POD was investigated by means of voxel-based morphometry. RESULTS: Excluding patients with outliers, 61 patients were included in the analyses. POD had occurred in 26 of the 61 patients (42.6%). Age and total WM volume were shown by multiple regression analysis to correlate significantly with the duration of POD (P < 0.05 and < 0.01, respectively). WM was significantly reduced in the temporal stem, and the reduction in volume correlated significantly with the duration of POD (P < 0.001). Gray matter atrophy was not associated with POD. CONCLUSIONS: We found that age and WM atrophy in the temporal stem are factors predictive of POD after DBS surgery. In aged patients with temporal stem atrophy, surgical procedures and postoperative management should be carefully explored to reduce the risk of postoperative delirium.
OBJECTIVE: The aim of this study was to investigate the incidence of and risk factors for postoperative delirium (POD) after deep brain stimulation (DBS) surgery in patients with Parkinson disease. METHODS: We analyzed the preoperative T1-weighted magnetic resonance imaging data of 71 patients with Parkinson disease who underwent DBS surgery. Multiple regression analysis was performed with age, l-dopa equivalent daily dose, laterality of the surgery, target regions, number of electrode trajectories tried, gray matter volume, and white matter (WM) volume as explanatory variables and the duration (number of days) of POD as the response variable. In addition, regional brain atrophy associated with POD was investigated by means of voxel-based morphometry. RESULTS: Excluding patients with outliers, 61 patients were included in the analyses. POD had occurred in 26 of the 61 patients (42.6%). Age and total WM volume were shown by multiple regression analysis to correlate significantly with the duration of POD (P < 0.05 and < 0.01, respectively). WM was significantly reduced in the temporal stem, and the reduction in volume correlated significantly with the duration of POD (P < 0.001). Gray matter atrophy was not associated with POD. CONCLUSIONS: We found that age and WM atrophy in the temporal stem are factors predictive of POD after DBS surgery. In aged patients with temporal stem atrophy, surgical procedures and postoperative management should be carefully explored to reduce the risk of postoperative delirium.
Authors: P R Kappen; E Kakar; C M F Dirven; M van der Jagt; M Klimek; R J Osse; A P J E Vincent Journal: Neurosurg Rev Date: 2021-08-16 Impact factor: 2.800
Authors: Pablo Kappen; Johannes Jeekel; Clemens M F Dirven; M Klimek; Steven A Kushner; Robert-Jan Osse; Michiel Coesmans; Marten J Poley; Arnaud J P E Vincent Journal: BMJ Open Date: 2021-10-01 Impact factor: 2.692