OBJECTIVE Functional stereotactic neurosurgery including deep brain stimulation (DBS) and radiofrequency lesioning is well established and widely used for treatment of movement disorders and various other neurological and psychiatric diseases. Although functional stereotactic neurosurgery procedures are considered relatively safe, intracranial hemorrhage resulting in permanent neurological deficits may occur in 1%-3% of patients. Microelectrode recording (MER) has been recognized as a valuable tool for refining the final target in functional stereotactic neurosurgery. Moreover, MER provides insight into the underlying neurophysiological pathomechanisms of movement disorders and other diseases. Nevertheless, there is an ongoing controversy on whether MER increases the risk for hemorrhage. The authors aimed to compare the risk of hemorrhage in functional stereotactic neurosurgical procedures with regard to the use of MER. METHODS The authors performed a comparative analysis on a consecutive series of 645 functional neurosurgery procedures, including 624 DBS surgeries and 21 radiofrequency lesionings, to evaluate whether the use of MER would increase the risk for hemorrhage. MER was performed in 396 procedures, while no MER was used in 249 cases. The MER technique involved the use of a guiding cannula and a single trajectory when feasible. Postoperative CT scans were obtained within 24 hours after surgery in all patients and screened for the presence of hemorrhage. RESULTS Twenty-one intracranial hemorrhages were detected on the postoperative CT scans (3.2%). Of the 21 intracranial hemorrhages, 14 were asymptomatic and 7 were symptomatic. Symptoms were transient except in 1 case. There was no statistically significant correlation between hemorrhage and the use of MER at any site (subdural, ventricle, trajectory, target, whether asymptomatic or symptomatic). There were 4 cases of symptomatic hemorrhage in the MER group (1%) and 3 cases in those without MER (1.2%). CONCLUSIONS Intraoperative MER did not increase the overall risk of hemorrhage in the authors' experience using primarily a single MER trajectory and a guiding cannula.

中文翻译：

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功能神经外科中的微电极记录和出血：连续 645 例手术的比较分析。

目的 包括深部脑刺激（DBS）和射频损伤在内的功能性立体定向神经外科手术已十分成熟，并广泛用于治疗运动障碍和各种其他神经和精神疾病。尽管功能性立体定向神经外科手术被认为相对安全，但 1%-3% 的患者可能会发生颅内出血，导致永久性神经功能缺损。微电极记录（MER）已被认为是完善功能性立体定向神经外科最终目标的宝贵工具。此外，MER 还提供了对运动障碍和其他疾病的潜在神经生理学病理机制的深入了解。然而，关于 MER 是否会增加出血风险仍存在争议。作者旨在比较功能性立体定向神经外科手术中使用 MER 的出血风险。方法 作者对连续 645 例功能神经外科手术（包括 624 例 DBS 手术和 21 例射频损伤）进行了比较分析，以评估使用 MER 是否会增加出血风险。396 例手术中进行了 MER，而 249 例中没有使用 MER。MER 技术涉及在可行的情况下使用引导插管和单一轨迹。所有患者均在术后 24 小时内进行术后 CT 扫描，并筛查是否存在出血。结果术后CT扫描发现21例颅内出血（3.2%）。21例颅内出血中，14例无症状，7例有症状。除 1 例外，症状均为暂时性。出血与任何部位（硬膜下、脑室、轨迹、目标，无论无症状或有症状）使用 MER 之间没有统计学上显着的相关性。MER组出现症状性出血4例（1%），无MER组出现症状性出血3例（1.2%）。结论 根据作者的经验，主要使用单一 MER 轨迹和引导插管的术中 MER 并未增加总体出血风险。