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Domino JS, Lundy P, Kaufman CB. Fulminant non-infectious peri-electrode edema after deep brain stimulation system implantation in a pediatric patient. Childs Nerv Syst 2022; 38:447-454. [PMID: 34057621 DOI: 10.1007/s00381-021-05224-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
Non-infectious peri-electrode edema is a rare complication after implantation of a deep brain stimulation (DBS) electrode. DBS is frequently used in the management of movement disorders with increasing interest surrounding its value in more rare disorders associated with movement abnormalities. This is the report of a 10-year-old male with Cockayne syndrome who acutely developed symptomatic non-infectious, non-hemorrhagic peri-electrode edema 18 days postoperatively from implantation of a DBS system targeting the bilateral globus pallidus internus. CT head confirmed extensive vasogenic edema along the entire length of the left electrode, and infectious workup was negative. The patient required admission to the pediatric intensive care unit for management utilizing steroid, hypertonic, and hyperosmolar therapy due to the amount of mass effect. Symptoms reduced over a 7-day hospital stay and were completely resolved at 1 month without removal of the DBS system. Management of this rare entity remains controversial and often involves the use of steroids and anti-epileptic prophylaxis. This represents the first case of non-infectious peri-electrode edema reported in a pediatric patient and is especially notable for its fulminant nature.
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Affiliation(s)
- Joseph S Domino
- Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3021, KS 66160, Kansas City, USA.
| | - Paige Lundy
- Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3021, KS 66160, Kansas City, USA
| | - Christian B Kaufman
- Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3021, KS 66160, Kansas City, USA.,Division of Neurosurgery, Children's Mercy Kansas City, Kansas City, MO, USA
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Tian Y, Wang J, Jiang L, Feng Z, Shi X, Hao Y. The need to be alert to complications of peri‐lead cerebral edema caused by deep brain stimulation implantation: A systematic literature review and meta‐analysis study. CNS Neurosci Ther 2022; 28:332-342. [PMID: 35044099 PMCID: PMC8841290 DOI: 10.1111/cns.13802] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/19/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background The compatibility of deep brain stimulation (DBS) hardware and MRI scans has greatly improved the diagnostic rate of postoperative peri‐lead edema (PLE). However, the etiology, incidence, and prognostic outcomes of this complication have not been established. Objective The incidence of PLE and associated symptoms, the process of occurrence and progression of this complication, as well as treatment strategies were evaluated. Methods We conducted a Preferred Reporting Items for Systematic Reviews and Meta‐Analyses compliant systematic review of all studies that reported on incidences of PLE and associated symptoms after DBS implantation. Through systematic literature review, we evaluated its causes, neuropsychiatric symptoms, duration, treatment methods, and prognostic outcomes. Results Our search retrieved 10 articles, including 5 articles on PLE and 10 articles on symptomatic PLE. The incidence of PLE was 35.8% (95% CI: 17.0%–54.6%), while the incidence of symptomatic PLE was 3.1% (95% CI: 1.5%–4.7%) accounting for 8.7% of PLE. Conclusions This complication is not as rare as previously reported. Therefore, it requires significant attention after DBS implantation. The correlation between its causes, duration, symptoms, and the area involved in edema should be assessed in long‐term prospective clinical studies with large sample sizes.
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Affiliation(s)
- Yu Tian
- Neurosurgery Department The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Jiaming Wang
- Neurosurgery Department The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Lei Jiang
- Neurosurgery Department The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Zhaohai Feng
- Neurosurgery Department The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Xin Shi
- Neurosurgery Department The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Yujun Hao
- Neurosurgery Department The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
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Nolt MJ, Polasani RS, Masnyk TW, Rezak M, Rosenow JM. Prospective Evaluation of the Time Course of White Matter Edema Associated with Implanted Deep Brain Stimulation Electrodes. Stereotact Funct Neurosurg 2020; 99:203-206. [PMID: 33221795 DOI: 10.1159/000511115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/24/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Deep brain stimulation (DBS) is commonly used in the treatment of medically refractory movement disorders. There have been several reports in the literature of edema developing around the implanted electrode. Most of these studies have been retrospective, suggesting that the time course and incidence of this edema are underestimated. An understanding of the incidence and time course of edema related to DBS leads is important to allow clinicians to better assess the correct course of action when edema following DBS implantation is observed. METHODS We examined both the time course and prevalence of edema following DBS implantation by obtaining a series of postoperative MRI scans from patients who underwent DBS surgery. Edema volume was quantified by a single neuroradiologist, measuring the peri-electrode T2 signal change. RESULTS We examined postoperative MRIs in thirteen patients with fifteen DBS electrode implants. Eleven patients exhibited white matter edema on at least 1 postoperative MRI, with none being symptomatic. Edema was completely resolved in 4 of the electrode implants through postoperative day 70, with the remaining cases still exhibiting edema at the last imaged time point. DISCUSSION/CONCLUSION In this study, we obtained a regimented series of postoperative MRIs in an effort to determine the time course and incidence of edema. Our results show that edema following DBS implant is not rare, is often asymptomatic, and may resolve over many weeks.
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Affiliation(s)
- Mark J Nolt
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA,
| | - Rajeev S Polasani
- Department of Radiology, Northwestern Medicine Central DuPage Hospital, Winfield, Illinois, USA
| | - Taras W Masnyk
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA
| | - Michael Rezak
- Neurosciences Institute, Vassar Hospital and Medical Center, Poughkeepsie, New York, USA
| | - Joshua M Rosenow
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA
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Lee JJ, Daniels B, Austerman RJ, Dalm BD. Symptomatic, left-sided deep brain stimulation lead edema 6 h after bilateral subthalamic nucleus lead placement. Surg Neurol Int 2019; 10:68. [PMID: 31528406 PMCID: PMC6744830 DOI: 10.25259/sni-125-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 02/19/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Deep brain stimulation (DBS) lead edema can be a serious, although rare, complication in the postoperative period. Of the few cases that have been reported, the range of presentation has been 33 h–120 days after surgery. Case Description: We report a case of a 75-year-old male with a history of Parkinson’s disease who underwent bilateral placement of subthalamic nucleus DBS leads that resulted in symptomatic, left-sided lead edema 6 h after surgery, which is the earliest reported case. Conclusions: DBS lead edema is noted to be a self-limiting phenomenon. It is critical to recognize the possibility of lead edema as a cause of postoperative encephalopathy even in the acute phase after surgery. Although it is important to rule out other causes of postoperative changes in the patient examination, the recognition of lead edema can help to avoid extraneous diagnostic tests or DBS lead revision or removal.
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Affiliation(s)
- Jonathan J Lee
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, United States
| | - Bradley Daniels
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, United States
| | - Ryan J Austerman
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, United States
| | - Brian D Dalm
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, United States
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Borellini L, Ardolino G, Carrabba G, Locatelli M, Rampini P, Sbaraini S, Scola E, Avignone S, Triulzi F, Barbieri S, Cogiamanian F. Peri-lead edema after deep brain stimulation surgery for Parkinson's disease: a prospective magnetic resonance imaging study. Eur J Neurol 2018; 26:533-539. [PMID: 30358915 DOI: 10.1111/ene.13852] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/16/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to define the prevalence and characteristics of peri-electrode edema in a prospective cohort of patients undergoing deep brain stimulation (DBS) surgery and to correlate it with clinical findings. METHODS We performed brain magnetic resonance imaging (MRI) between 7 and 20 days after surgery in 19 consecutive patients undergoing DBS surgery for Parkinson's disease. The T2-weighted hyperintensity surrounding DBS leads was characterized and quantified. Any evidence of bleeding around the leads was also evaluated. Clinical and follow-up data were recorded. In a subgroup of patients, a follow-up MRI was performed 3-6 weeks after surgery. We also retrospectively reviewed the post-operative computed tomography scans of patients who underwent DBS at our center since 2013. RESULTS Magnetic resonance imaging showed a peri-lead edematous reaction in all (100%) patients, which was unilateral in three patients (15.8%). In six patients (31.6%), we detected minor peri-lead hemorrhage. Edema completely resolved in eight out of 11 patients with a follow-up MRI and was markedly reduced in the others. Most patients were asymptomatic but six (31.6%) manifested various degrees of confusional state without motor symptoms. We found no significant correlation between edema volume, distribution and any clinical feature, including new post-operative neurological symptoms. The retrospective computed tomography analysis showed that peri-electrode hypodensity consistent with edema is absent at early post-operative imaging but is common at scans performed >3 days after surgery. CONCLUSIONS Peri-electrode edema is a common, transient reaction to DBS lead placement and a convincing relation between edema and post-operative clinical status is lacking.
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Affiliation(s)
- L Borellini
- U.O. Neurofisiopatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - G Ardolino
- U.O. Neurofisiopatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - G Carrabba
- U.O. Neurochirurgia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - M Locatelli
- U.O. Neurochirurgia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - P Rampini
- U.O. Neurochirurgia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - S Sbaraini
- U.O. Neuroradiologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - E Scola
- U.O. Neuroradiologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - S Avignone
- U.O. Neuroradiologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - F Triulzi
- U.O. Neuroradiologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Dipartimento di Fisiopatologia e dei Trapianti, Università degli Studi di Milano, Milano, Italy
| | - S Barbieri
- U.O. Neurofisiopatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - F Cogiamanian
- U.O. Neurofisiopatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Schoen NB, Jermakowicz WJ, Luca CC, Jagid JR. Acute symptomatic peri-lead edema 33 hours after deep brain stimulation surgery: a case report. J Med Case Rep 2017; 11:103. [PMID: 28407815 PMCID: PMC5391613 DOI: 10.1186/s13256-017-1275-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 03/21/2017] [Indexed: 11/10/2022] Open
Abstract
Background Symptomatic peri-lead edema is a rare complication of deep brain stimulation that has been reported to develop 4 to 120 days postoperatively. Case presentation Here we report the case of a 63-year-old Hispanic man with an 8-year history of Parkinson’s disease who underwent bilateral placement of subthalamic nucleus deep brain stimulation leads and presented with acute, symptomatic, unilateral, peri-lead edema just 33 hours after surgery. Conclusions We document a thorough radiographic time course showing the evolution of these peri-lead changes and their regression with steroid therapy, and discuss the therapeutic implications of these findings. We propose that the unilateral peri-lead edema after bilateral deep brain stimulation is the result of severe microtrauma with blood–brain barrier disruption. Knowledge of such early manifestation of peri-lead edema after deep brain stimulation is critical for ruling out stroke and infection and preventing unnecessary diagnostic testing or hardware removal in this rare patient population.
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Affiliation(s)
- Nathan B Schoen
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1150 NW 14th St., Miami, Florida, 33136, USA.
| | - Walter J Jermakowicz
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1150 NW 14th St., Miami, Florida, 33136, USA
| | - Corneliu C Luca
- University of Miami Miller School of Medicine, 1150 NW 14th St., Miami, Florida, 33136, USA
| | - Jonathan R Jagid
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1150 NW 14th St., Miami, Florida, 33136, USA
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