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Asahi T, Ikeda K, Yamamoto J, Muro Y, Mori A, Yamamoto N. Cerebrospinal Fluid Leakage to the Chest Subcutaneous Pocket Due to Aggressive Brain Edema around the Leads for Deep Brain Stimulation: A Case Report and Literature Review. NMC Case Rep J 2022; 9:357-363. [PMID: 36447750 PMCID: PMC9662852 DOI: 10.2176/jns-nmc.2022-0157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/21/2022] [Indexed: 06/16/2023] Open
Abstract
Cerebral edema around the lead has been reported as a complication of deep brain stimulation; however, the causes remain unknown. Herein, we present a rare case of sudden cerebral edema around the lead occurring after deep brain stimulation. This was accompanied by cerebrospinal fluid (CSF) leakage into the subcutaneous thoracic pocket around the implantable pulse generator in a 53-year-old man with Parkinson's disease. No such case has been reported thus far. Lumbar drainage was performed to improve CSF leakage. The cerebral edema initially responded to steroids, but then it stopped responding to treatment. The edema appeared alternately on the left and right sides, and cyst formation was noted around the left lead. There are some reports of cyst formation around the lead; however, in our case, images were used to monitor the edema and cyst from their appearance to their disappearance. Our data suggest that cyst formation and cerebral edema are related.
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Affiliation(s)
- Takashi Asahi
- Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Nonoichi, Ishikawa, Japan
| | - Kiyonobu Ikeda
- Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Nonoichi, Ishikawa, Japan
| | - Jiro Yamamoto
- Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Nonoichi, Ishikawa, Japan
| | - Yuko Muro
- Department of Clinical Engineering, Kanazawa Neurosurgical Hospital, Nonoichi, Ishikawa, Japan
| | - Atsuko Mori
- Department of Neurology, Kanazawa Neurosurgical Hospital, Nonoichi, Ishikawa, Japan
| | - Nobutaka Yamamoto
- Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Nonoichi, Ishikawa, Japan
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Lu Y, Qiu C, Chang L, Luo B, Dong W, Zhang W, Sun HH. Development of Unilateral Peri-Lead Edema Into Large Cystic Cavitation After Deep Brain Stimulation: A Case Report. Front Neurol 2022; 13:886188. [PMID: 35677329 PMCID: PMC9168029 DOI: 10.3389/fneur.2022.886188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Importance Deep brain stimulation (DBS) has been approved to treat a variety of movement disorders, including Parkinson's disease (PD), essential tremor, and dystonia. Following the DBS surgery, some perioperative and even delayed complications due to intracranial and hardware-related events could occur, which may be life-threatening and require immediate remedial measures. Clinical Presentation We report a case of an older woman with advanced PD who developed the unique complication of unilateral cyst formation at the tip of the DBS electrode after undergoing bilateral placement of subthalamic nucleus DBS. After a period of controlled motor symptoms, the patient showed new neurological deficits related to right peri-lead edema. However, the new neurological symptoms regressed quickly over several days with stereotactic implantation of a puncture needle to drain the cyst fluid without removing the affected lead. Conclusion The occurrence of an intraparenchymal cyst following DBS surgery is a rare but life-threatening complication that could relate to edema around the electrodes or cerebrospinal fluid tracking. Stereotactic aspiration makes the intracranial cyst regress safely and effectively and ensures that the electrode is in the optimal position of the target nucleus to achieve an effective DBS surgery.
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Affiliation(s)
- Yue Lu
- Department of Functional Neurosurgery, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Chang Qiu
- Department of Functional Neurosurgery, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Lei Chang
- Department of Functional Neurosurgery, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Bei Luo
- Department of Functional Neurosurgery, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Wenwen Dong
- Department of Functional Neurosurgery, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Wenbin Zhang
- Department of Functional Neurosurgery, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
- *Correspondence: Wenbin Zhang
| | - Hai-Hua Sun
- Department of Neurology, Yancheng Hospital Affiliated Southeast University Medical College, Yancheng, China
- Hai-Hua Sun
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3
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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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Fenoy AJ, Conner CR, Withrow JS, Hocher AW. Case report of hyperacute edema and cavitation following deep brain stimulation lead implantation. Surg Neurol Int 2020; 11:259. [PMID: 33024597 PMCID: PMC7533082 DOI: 10.25259/sni_527_2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 07/18/2020] [Indexed: 01/07/2023] Open
Abstract
Background: Postoperative cerebral edema around a deep brain stimulation (DBS) electrode is an uncommonly reported complication of DBS surgery. The etiology of this remains unknown, and the presentation is highly variable; however, the patients generally report a good outcome. Case Description: Here, we report an unusual presentation of postoperative edema in a 66-year-old female who has bilateral dentatorubrothalamic tract (specifically, the ventral intermediate nucleus) DBS for a mixed type tremor disorder. Initial postoperative computed tomography (CT) was unremarkable and the patient was admitted for observation. She declined later on postoperative day (POD) 1 and became lethargic. Stat head CT scan performed revealed marked left-sided peri-lead edema extending into the centrum semiovale with cystic cavitation, and trace right-sided edema. On POD 2, the patient was alert, but with global aphasia, right-sided neglect, and a plegic right upper extremity. Corticosteroids were started and a complete infectious workup was unremarkable. She was intubated and ultimately required a tracheostomy and percutaneous gastrostomy tube. She returned to the clinic 3 months postoperatively completely recovered and ready for battery implantation. Conclusion: While this is an unusual presentation of cerebral edema following DBS placement, ultimately, the outcome was good similar to other reported cases. Supportive care and corticosteroids remain the treatment of choice for this phenomenon.
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Affiliation(s)
- Albert J Fenoy
- Movement Disorders and Neurodegenerative Disease Program, Departments of Neurology, McGovern Medical School, Houston, Texas, United States.,Movement Disorders and Neurodegenerative Disease Program, Departments of Neurosurgery, McGovern Medical School, Houston, Texas, United States
| | - Christopher R Conner
- Movement Disorders and Neurodegenerative Disease Program, Departments of Neurosurgery, McGovern Medical School, Houston, Texas, United States
| | - Joseph S Withrow
- Movement Disorders and Neurodegenerative Disease Program, Departments of Neurosurgery, McGovern Medical School, Houston, Texas, United States
| | - Aaron W Hocher
- Movement Disorders and Neurodegenerative Disease Program, Departments of Neurosurgery, McGovern Medical School, Houston, Texas, United States
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Habibi SAH, Shahidi G, Parvaresh M, Fasano A, Pouranian M, Yazdi N, Modara F, Mehdizadeh M, Taghizadeh G, Rohani M. Cerebral peri-lead edema following deep brain stimulation surgery. Neurol Sci 2019; 41:473-475. [PMID: 31468236 DOI: 10.1007/s10072-019-04042-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 08/13/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Seyed Amir Hassan Habibi
- Department of Neurology, Rasoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Gholamali Shahidi
- Department of Neurology, Firoozgar Hospital, Iran University of Medical Science, Tehran, Iran
| | - Mansour Parvaresh
- Department of Neurosurgery, Rasoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Maryam Pouranian
- Department of Neurology, Rasoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Narges Yazdi
- Department of Neurology, Rasoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Farhad Modara
- Department of Neurology, Mostafa Khomeini Hospital, Ilam University of Medical Science, Ilam, Iran
| | - Maryam Mehdizadeh
- Department of Neuroscience, Faculty of advance Technology of medicine, Iran University of Medical Science, Tehran, Iran
| | - Ghorban Taghizadeh
- Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Rohani
- Department of Neurology, Rasoul Akram Hospital, Iran University of Medical Science, Tehran, Iran. .,Division of Neurology - Hazrat Rasool Hospital, Iran University of Medical Sciences, Niyayesh St., Sattarkhan Ave, Tehran, 1445613131, Iran.
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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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Fernández-Pajarín G, Sesar A, Ares B, Relova JL, Arán E, Gelabert-González M, Castro A. Delayed complications of deep brain stimulation: 16-year experience in 249 patients. Acta Neurochir (Wien) 2017. [PMID: 28646465 DOI: 10.1007/s00701-017-3252-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Over the years, most of the deep brain stimulation (DBS) complications described have been mainly related to the surgery itself or the stimulation. Only a few authors have dealt with chronic complications or complications due to implanted material. METHODS We retrospectively analyzed complications beyond the 1st month after surgery in 249 patients undergoing DBS at our site for 16 years, with 321 interventions overall. RESULTS Our results show that infection is the most frequent delayed complication (12.5%), the pulse generator being the most common location. Lead breaks (9.3%) are the second most frequent complication. Symptomatic peri-lead edema and cyst formation were exceptional. CONCLUSIONS The best knowledge about DBS complications allows for better solutions. In case of infection, conservative treatment or partial removal of the DBS system appears to be safe and reasonable. Intracranial complications related to DBS material such as peri-lead edema and cyst formation have a good prognosis. They may appear long after DBS implantation.
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Affiliation(s)
| | - A Sesar
- Department of Neurology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - B Ares
- Department of Neurology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - J L Relova
- Department of Neurophysiology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - E Arán
- Department of Neurosurgery, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - M Gelabert-González
- Department of Neurosurgery, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - A Castro
- Department of Neurology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
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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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Fenoy AJ, Villarreal SJ, Schiess MC. Acute and Subacute Presentations of Cerebral Edema following Deep Brain Stimulation Lead Implantation. Stereotact Funct Neurosurg 2017; 95:86-92. [PMID: 28208150 DOI: 10.1159/000454892] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 12/02/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIMS Postoperative cerebral edema around a deep brain stimulation (DBS) electrode is an uncommon reported complication. The goal of this study was to identify instances of postoperative edema based on clinical presentation, and to remark on their management. METHODS A retrospective chart review was performed on all patients who underwent DBS electrode implantation over a 3-year period. Routine CT imaging on postoperative day (POD) 1 was negative. Patients were identified based on clinical neurological changes, leading to imaging and subsequent diagnosis. RESULTS Five of 145 patients (3.4%) presented with new neurological symptoms from POD 1 to 14, which were confirmed by CT imaging to show perilead and/or subcortical edema around 6 of 281 electrodes (2.1%). Four of 5 patients had unilateral edema despite bilateral implantation. Clinical presentations varied widely. Two patients presenting on POD 1 with deteriorating conditions required longer inpatient stays with supportive measures than those presenting later (p = 0.0002). All patients were treated with corticosteroids and returned to baseline by 3 months after surgery. CONCLUSIONS Acute instances of DBS lead edema may occur as early as POD 1 and can rapidly progress into profound deficits. Treatment with supportive care and corticosteroids is otherwise identical to those cases presenting later.
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Affiliation(s)
- Albert J Fenoy
- Department of Neurosurgery, Mischer Neuroscience Institute, University of Texas - Houston Health Science Center, Houston, TX, USA
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