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Background: Hemorrhage is a dangerous complication of deep brain stimulation (DBS) surgery, but a comprehensive explanation of the associated risk factors remains inconclusive, particularly application of microelectrode recording (MER) compared with macrostimulation (non-MER)-based DBS procedures. We conducted a comparative analysis of MER and macrostimulation techniques, evaluating the impact of brain penetrations by microelectrode guiding cannulas on the occurrence of intracranial hemorrhagic events., Methods: This retrospective study included all DBS procedures (MER-based and non-MER-based) performed at a single medical center from November 2008 to June 2023. Patients underwent comprehensive preoperative and postoperative evaluations, including postoperative computed tomography to assess lead placement and intracranial bleeding, categorized as symptomatic or asymptomatic. Statistical analyses were conducted to ascertain the correlation between different surgical techniques and the risk of hemorrhagic complications., Results: In a cohort of 618 patients, 1096 electrodes were implanted during 672 consecutive DBS procedures. There were 21 asymptomatic and 6 symptomatic intracranial hemorrhages (ICHs), including 1 death. The bleeding rate was 4.37% per patient and 2.92% per electrode. Patients who developed hematomas were more prevalent in the MER group (25 cases) compared with the non-MER group (2 cases). The MER group had a higher mean number of brain penetrations by guiding cannulas., Conclusions: DBS procedures are generally safe, with only 0.97% resulting in long-term or permanent deficits. All symptomatic ICH occurred in MER-based procedures, whereas macrostimulation was associated with only 2 asymptomatic ICH cases. The higher number of brain penetrations in MER correlates with higher bleeding rates., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Temporal lobe epilepsy (TLE) is the most common form of drug-resistant epilepsy. The main pathological changes primarily involve hippocampal sclerosis (HS). Early resective surgery of the sclerotic hippocampus is typically associated with favorable clinical outcomes. However, not all patients are suitable candidates for resective surgery of mesial temporal lobe structures. Therefore, alternative treatment modalities should be considered. We present the case of a 50-year-old right-handed woman with left HS who underwent unilateral subiculum stimulation for drug-resistant epilepsy (DRE). Since the age of 10, the patient had been experiencing focal to bilateral tonic-clonic seizures (FBTCS). Despite multiple antiseizure medications, she experienced 12 to 17 FBTCS per month in the last two years. Due to concerns about potential memory decline and personal preferences, she refused resective surgery. As an alternative, the patient underwent left unilateral subiculum stimulation. The stimulation resulted in a nearly 67 % reduction in seizure frequency at the last follow-up (20 months after surgery). This case highlights that drug-resistant epilepsy may be effectively treated with subicular stimulation in patients with HS., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Inc.)