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Background: Indications for deep brain stimulation (DBS) are rapidly growing within functional neurosurgery. The objective of this study was to characterize national trends in demographics and complications across distinct populations of DBS patients. Methods: We identified patients from the 2008–2018 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use Data File (PUF) who underwent an implantation or revision procedure for DBS. Summary statistics for postoperative infection rate, noninfectious complication rate, total hospital length of stay, discharge disposition, mortality, reoperation or readmission, and time from operation to readmission were obtained. Patients were categorized by diagnosis for DBS treatment. Outcomes for each diagnosis group were compared to outcomes for the total study population. Results: DBS patients who underwent primary implantation procedures had low rates of postoperative infections (1.2%), noninfectious complications (0.8%), and mortality (0.1%) and a high likelihood of discharge home (97.6%). In addition, a large percentage of patients presented for revision or removal of neurostimulators (34.2% of cases) or treatment of long-term hardware infection (4.5%). Compared with patients with other diagnoses, patients with Parkinson disease experienced lower rates of noninfectious complications (odds ratio 0.32; 95% CI, 0.15–0.63; p = 0.002) and fewer unplanned reoperations (odds ratio 0.60; 95% CI, 0.39–0.92; p = 0.02). Conclusion: Analysis of a national database suggests that DBS is a relatively safe treatment across several different patient populations. These overall favorable results support the continued practice of DBS surgery and provide encouraging validation for increasing access to DBS therapy for new indications that are being actively investigated.

Arteriovenous malformations (AVMs) of the brain are abnormal connections between the arterial and venous cerebral vasculature that often lead to intracranial hemorrhage (ICH). The diagnosis of AVMs often takes place in the setting of ICH, however, there is no clear consensus on how to manage critically ill, comatose patients and whether it is best to treat the lesion initially. We present an initial treatment strategy that is focused on the management of intracranial hypertension by the means of decompressive craniectomy (DC) coupled with delayed AVM management. We retrospectively reviewed the medical records of three patients who arrived with ICH, obliterated cisterns, and midline shifts greater than 5mm from ruptured AVMs. Each of these patients received a DC, with later definite treatment for their AVMs and cranioplasties. We reported the preoperative and postoperative clinical status of patients using Glasgow Coma Scale (GCS) outcomes as well as physical exam findings. All three patients were transferred to the intensive care immediately after DC and had significant clinical improvement 15 days post-craniectomy. All patients underwent definitive AVM treatment within 6 weeks of the initial procedure. One patient was treated with endovascular-only embolization while the other two received surgical treatment. Patients showed a significant improvement in neurological status and clinical outcome. Decompressive hemicraniectomies may have a positive impact on mortality and neurological outcomes for select patients with cerebral hemorrhage originating from vascular malformations, especially in low-resource scenarios.