1
|
Raguž M, Marčinković P, Chudy H, Orešković D, Lakić M, Dlaka D, Katavić N, Rački V, Vuletić V, Chudy D. Decreased brain volume may be associated with the occurrence of peri-lead edema in Parkinson's disease patients with deep brain stimulation. Parkinsonism Relat Disord 2024; 121:106030. [PMID: 38354427 DOI: 10.1016/j.parkreldis.2024.106030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/12/2024] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Peri-lead edema (PLE) is a poorly understood complication of deep brain stimulation (DBS), which has been described in patients presenting occasionally with profound and often delayed symptoms with an incidence ranging from 0.4% up to even 100%. Therefore, our study aims to investigate the association of brain and brain compartment volumes on magnetic resonance imaging (MRI) with the occurrence of PLE in Parkinson's disease (PD) patients after DBS implantation in subthalamic nuclei (STN). METHODS This retrospective study included 125 consecutive PD patients who underwent STN DBS at the Department of Neurosurgery, Dubrava University Hospital from 2010 to 2022. Qualitative analysis was done on postoperative MRI T2-weighted sequence by two independent observers, marking PLE on midbrain, thalamus, and subcortical levels as mild, moderate, or severe. Quantitative volumetric analysis of brain and brain compartment volumes was conducted using an automated CIVET processing pipeline on preoperative MRI T1 MPRAGE sequences. In addition, observed PLE on individual hemispheres was delineated manually and measured using Analyze 14.0 software. RESULTS In our cohort, PLE was observed in 32.17%, mostly bilaterally. Mild PLE was observed in the majority of patients, regardless of the level observed. Age, sex, diabetes, hypertension, vascular disease, and the use of anticoagulant/antiplatelet therapy showed no significant association with the occurrence of PLE. Total grey matter volume showed a significant association with the PLE occurrence (r = -0.22, p = 0.04), as well as cortex volume (r = -0.32, p = 0.0005). Cortical volumes of hemispheres, overall hemisphere volumes, as well as hemisphere/total intracranial volume ratio showed significant association with the PLE occurrence. Furthermore, the volume of the cortex and total grey volume represent moderate indicators, while hemisphere volumes, cortical volumes of hemispheres, and hemisphere/total intracranial volume ratio represent mild to moderate indicators of possible PLE occurrence. CONCLUSION The results of our study suggest that the morphometric MRI measurements, as a useful tool, can provide relevant information about the structural status of the brain in patients with PD and represent moderate indicators of possible PLE occurrence. Identifying patients with greater brain atrophy, especially regarding grey matter before DBS implantation, will allow us to estimate the possible postoperative symptoms and intervene in a timely manner. Further studies are needed to confirm our findings and to investigate other potential predictors and risk factors of PLE occurrence.
Collapse
Affiliation(s)
- Marina Raguž
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; School of Medicine, Catholic University of Croatia, Zagreb, Croatia.
| | - Petar Marčinković
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Hana Chudy
- Department of Neurology, Dubrava University Hospital, Zagreb, Croatia
| | - Darko Orešković
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Marin Lakić
- Department of Neurosurgery, Dubrovnik General Hospital, Dubrovnik, Croatia
| | - Domagoj Dlaka
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Nataša Katavić
- Department of Radiology and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia
| | - Valentino Rački
- Department of Neurology, University Hospital Centre, Rijeka, Croatia
| | - Vladimira Vuletić
- Department of Neurology, University Hospital Centre, Rijeka, Croatia
| | - Darko Chudy
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; Department of Surgery, School of Medicine University of Zagreb, Zagreb, Croatia
| |
Collapse
|
2
|
Wu B, Ling Y, Zhang C, Xu J, Yang C, Jiang N, Chen L, Liu J. Postoperative use of steroids for peri-electrode edema after deep brain stimulation surgery: A retrospective cohort study. CNS Neurosci Ther 2024; 30:e14470. [PMID: 37715573 PMCID: PMC10916416 DOI: 10.1111/cns.14470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/21/2023] [Accepted: 09/04/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND To review the incidence and extent of peri-electrode edema after DBS and to clarify the effect of postoperative use of steroids on the peri-electrode edema. METHODS This retrospective cohort study included 250 patients who underwent bilateral subthalamic nucleus (STN) DBS surgery with intact MRI within 1 month after DBS surgery. Patients were divided into steroid and non-steroid groups, based on postoperative steroids use. The occurrence and extent of peri-electrode edema were compared between the two groups, and other associated factors were analyzed using univariate and multivariate methods. RESULTS Peri-electrode edema >1 cm3 in at least one hemisphere was reported in 215 (86.00%) patients. The mean volume of peri-electrode edema observed in the steroid group was significantly smaller than in the non-steroid group (8.09 ± 8.47 cm3 vs 17.10 ± 16.90 cm3 , p < 0.001). In the steroid group, 104 (32.91%) of the 316 implanted electrodes present with edema less than 1 cm3 , whereas in the non-steroid group, only 27 (14.67%) of the 184 implanted electrodes present with edema less than 1 cm3 (p < 0.001). Multivariate analysis indicated that lesser peri-electrode edema was significantly associated with postoperative steroids use and general anesthesia. CONCLUSIONS Peri-electrode edema is common after DBS surgery, and postoperative steroids use reduces the occurrence and extent of peri-electrode edema.
Collapse
Affiliation(s)
- Bin Wu
- Department of Neurosurgery, First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
- Department of Neurology, First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Yuting Ling
- Department of Anesthesiology, First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Changming Zhang
- Department of Neurosurgery, First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Jiakun Xu
- Department of Neurosurgery, First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Chao Yang
- Department of Neurosurgery, First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Nan Jiang
- Department of Anesthesiology, First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Ling Chen
- Department of Neurology, First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Jinlong Liu
- Department of Neurosurgery, First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| |
Collapse
|
3
|
Giordano M, Innocenti N, Rizzi M, Rinaldo S, Nazzi V, Eleopra R, Levi V. Incidence and management of idiopathic peri-lead edema (IPLE) following deep brain stimulation (DBS) surgery: Case series and review of the literature. Clin Neurol Neurosurg 2023; 234:108009. [PMID: 37857234 DOI: 10.1016/j.clineuro.2023.108009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/30/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Idiopathic peri-lead edema (IPLE) is being increasingly described as a potential complication occurring after DBS surgery. Its incidence and relationship to post-operative symptoms, though, are still poorly defined and its understanding and management yet limited. METHODS We reviewed delayed (≥ 72 h) post-operative CT imaging of patients who underwent DBS surgery at our Institution. A comparison of clinical and laboratory findings was carried out between patients with IPLE and controls. RESULTS 61 patients, accounting for 115 electrodes, were included. Incidence of IPLE was 37.7 % per patient and 29.5 % per electrode. Patients with IPLE were significantly older than controls (52.82 ± 15.65 years vs 44.73 ± 18.82 years, p = 0.04). There was no difference in incidence of new-onset neurological symptoms between patients with IPLE and controls. Longer operative time (180.65 ± 34.30 min vs 158.34 ± 49.28 min, p = 0.06) and a greater number of MERs per electrode were associated with IPLE (3.37 ± 1.21 vs 3.00 ± 1.63, p = 0.089), though these comparisons did not meet the statistical significance. None of the patients with IPLE underwent hardware removal, with IPLE vanishing spontaneously over months. CONCLUSIONS IPLE is an underestimated, benign event that may occur after DBS surgery. Age, longer operative time and MER use may represent risk factors for IPLE formation, but further studies are needed. The presence of post-operative neurological symptoms and fever was not associated with IPLE presence, highlighting its benign nature and suggesting that empiric treatment may not be always justified.
Collapse
Affiliation(s)
- Martina Giordano
- Functional Neurosurgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Niccolò Innocenti
- Functional Neurosurgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Michele Rizzi
- Functional Neurosurgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Rinaldo
- Parkinson and Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vittoria Nazzi
- Functional Neurosurgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vincenzo Levi
- Functional Neurosurgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| |
Collapse
|
4
|
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: 0] [Impact Index Per Article: 0] [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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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: 2] [Impact Index Per Article: 1.0] [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.
Collapse
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
| |
Collapse
|
7
|
Koh EJ, Golubovsky JL, Rammo R, Momin A, Walter B, Fernandez HH, Machado A, Nagel SJ. Estimating the Risk of Deep Brain Stimulation in the Modern Era: 2008 to 2020. Oper Neurosurg (Hagerstown) 2021; 21:277-290. [PMID: 34392372 DOI: 10.1093/ons/opab261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/16/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) was first approved by the United States Food and Drug Administration in 1997. Although the fundamentals of DBS remain the same, hardware, software, and imaging have evolved significantly. OBJECTIVE To test our hypothesis that the aggregate complication rate in the medical literature in the past 12 years would be lower than what is often cited based on early experience with DBS surgery. METHODS PubMed, PsycINFO, and EMBASE were queried for studies from 2008 to 2020 that included patients treated with DBS from 2007 to 2019. This yielded 34 articles that evaluated all complications of DBS surgery, totaling 2249 patients. RESULTS The overall complication rate in this study was 16.7% per patient. There was found to be a systemic complication rate of 0.89%, intracranial complication rate of 2.7%, neurological complication rate of 4.6%, hardware complication rate of 2.2%, and surgical site complication rate of 3.4%. The infection and erosion rate was 3.0%. CONCLUSION This review suggests that surgical complication rates have decreased since the first decade after DBS was first FDA approved. Understanding how to minimize complications from the inception of a technique should receive more attention.
Collapse
Affiliation(s)
- Eun Jeong Koh
- Department of Neurosurgery, Jeonbuk National University Medical School, Jeonju, Jeonbuk, Republic of Korea
| | - Joshua L Golubovsky
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Richard Rammo
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arbaz Momin
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Benjamin Walter
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hubert H Fernandez
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| | - Andre Machado
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sean J Nagel
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
8
|
Peng S, Dhawan V, Eidelberg D, Ma Y. Neuroimaging evaluation of deep brain stimulation in the treatment of representative neurodegenerative and neuropsychiatric disorders. Bioelectron Med 2021; 7:4. [PMID: 33781350 PMCID: PMC8008578 DOI: 10.1186/s42234-021-00065-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/02/2021] [Indexed: 01/16/2023] Open
Abstract
Brain stimulation technology has become a viable modality of reversible interventions in the effective treatment of many neurological and psychiatric disorders. It is aimed to restore brain dysfunction by the targeted delivery of specific electronic signal within or outside the brain to modulate neural activity on local and circuit levels. Development of therapeutic approaches with brain stimulation goes in tandem with the use of neuroimaging methodology in every step of the way. Indeed, multimodality neuroimaging tools have played important roles in target identification, neurosurgical planning, placement of stimulators and post-operative confirmation. They have also been indispensable in pre-treatment screen to identify potential responders and in post-treatment to assess the modulation of brain circuitry in relation to clinical outcome measures. Studies in patients to date have elucidated novel neurobiological mechanisms underlying the neuropathogenesis, action of stimulations, brain responses and therapeutic efficacy. In this article, we review some applications of deep brain stimulation for the treatment of several diseases in the field of neurology and psychiatry. We highlight how the synergistic combination of brain stimulation and neuroimaging technology is posed to accelerate the development of symptomatic therapies and bring revolutionary advances in the domain of bioelectronic medicine.
Collapse
Affiliation(s)
- Shichun Peng
- Center for Neurosciences, Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, New York, 11030, USA
| | - Vijay Dhawan
- Center for Neurosciences, Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, New York, 11030, USA
| | - David Eidelberg
- Center for Neurosciences, Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, New York, 11030, USA
| | - Yilong Ma
- Center for Neurosciences, Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, New York, 11030, USA.
| |
Collapse
|
9
|
Krauss JK, Lipsman N, Aziz T, Boutet A, Brown P, Chang JW, Davidson B, Grill WM, Hariz MI, Horn A, Schulder M, Mammis A, Tass PA, Volkmann J, Lozano AM. Technology of deep brain stimulation: current status and future directions. Nat Rev Neurol 2020; 17:75-87. [PMID: 33244188 DOI: 10.1038/s41582-020-00426-z] [Citation(s) in RCA: 268] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 01/20/2023]
Abstract
Deep brain stimulation (DBS) is a neurosurgical procedure that allows targeted circuit-based neuromodulation. DBS is a standard of care in Parkinson disease, essential tremor and dystonia, and is also under active investigation for other conditions linked to pathological circuitry, including major depressive disorder and Alzheimer disease. Modern DBS systems, borrowed from the cardiac field, consist of an intracranial electrode, an extension wire and a pulse generator, and have evolved slowly over the past two decades. Advances in engineering and imaging along with an improved understanding of brain disorders are poised to reshape how DBS is viewed and delivered to patients. Breakthroughs in electrode and battery designs, stimulation paradigms, closed-loop and on-demand stimulation, and sensing technologies are expected to enhance the efficacy and tolerability of DBS. In this Review, we provide a comprehensive overview of the technical development of DBS, from its origins to its future. Understanding the evolution of DBS technology helps put the currently available systems in perspective and allows us to predict the next major technological advances and hurdles in the field.
Collapse
Affiliation(s)
- Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Nir Lipsman
- Department of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tipu Aziz
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alexandre Boutet
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Peter Brown
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Benjamin Davidson
- Department of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Marwan I Hariz
- Department of Clinical Neuroscience, University of Umea, Umea, Sweden
| | - Andreas Horn
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité Medicine University of Berlin, Berlin, Germany
| | - Michael Schulder
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Antonios Mammis
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Peter A Tass
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Jens Volkmann
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany.,Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
10
|
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: 4] [Impact Index Per Article: 1.0] [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.
Collapse
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
| |
Collapse
|
11
|
Park HR, Lim YH, Song EJ, Lee JM, Park K, Park KH, Lee WW, Kim HJ, Jeon B, Paek SH. Bilateral Subthalamic Nucleus Deep Brain Stimulation under General Anesthesia: Literature Review and Single Center Experience. J Clin Med 2020; 9:jcm9093044. [PMID: 32967337 PMCID: PMC7564882 DOI: 10.3390/jcm9093044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/13/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023] Open
Abstract
Bilateral subthalamic nucleus (STN) Deep brain stimulation (DBS) is a well-established treatment in patients with Parkinson's disease (PD). Traditionally, STN DBS for PD is performed by using microelectrode recording (MER) and/or intraoperative macrostimulation under local anesthesia (LA). However, many patients cannot tolerate the long operation time under LA without medication. In addition, it cannot be even be performed on PD patients with poor physical and neurological condition. Recently, it has been reported that STN DBS under general anesthesia (GA) can be successfully performed due to the feasible MER under GA, as well as the technical advancement in direct targeting and intraoperative imaging. The authors reviewed the previously published literature on STN DBS under GA using intraoperative imaging and MER, focused on discussing the technique, clinical outcome, and the complication, as well as introducing our single-center experience. Based on the reports of previously published studies and ours, GA did not interfere with the MER signal from STN. STN DBS under GA without intraoperative stimulation shows similar or better clinical outcome without any additional complication compared to STN DBS under LA. Long-term follow-up with a large number of the patients would be necessary to validate the safety and efficacy of STN DBS under GA.
Collapse
Affiliation(s)
- Hye Ran Park
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea;
| | - Yong Hoon Lim
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea; (Y.H.L.); (E.J.S.)
| | - Eun Jin Song
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea; (Y.H.L.); (E.J.S.)
| | - Jae Meen Lee
- Department of Neurosurgery, Pusan National University Hospital, Busan 49241, Korea;
| | - Kawngwoo Park
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon 21565, Korea;
| | - Kwang Hyon Park
- Department of Neurosurgery, Chuungnam National University Sejong Hospital, Sejong 30099, Korea;
| | - Woong-Woo Lee
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Korea;
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul 03080, Korea; (H.-J.K.); (B.J.)
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul 03080, Korea; (H.-J.K.); (B.J.)
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea; (Y.H.L.); (E.J.S.)
- Correspondence: ; Tel.: +82-22-072-2876
| |
Collapse
|
12
|
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: 0] [Impact Index Per Article: 0] [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.
| |
Collapse
|
13
|
Sterman J, Cunqueiro A, Dym RJ, Spektor M, Lipton ML, Revzin MV, Scheinfeld MH. Implantable Electronic Stimulation Devices from Head to Sacrum: Imaging Features and Functions. Radiographics 2019; 39:1056-1074. [DOI: 10.1148/rg.2019180088] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jonathan Sterman
- From the Department of Radiology, Division of Emergency Radiology (J.S., A.C., M.L.L., M.H.S.), Department of Psychiatry and Behavioral Sciences (M.L.L.), and Dominick P. Purpura Department of Neuroscience (M.L.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467; Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.); and Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (M.S., M.V.R.)
| | - Alain Cunqueiro
- From the Department of Radiology, Division of Emergency Radiology (J.S., A.C., M.L.L., M.H.S.), Department of Psychiatry and Behavioral Sciences (M.L.L.), and Dominick P. Purpura Department of Neuroscience (M.L.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467; Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.); and Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (M.S., M.V.R.)
| | - R. Joshua Dym
- From the Department of Radiology, Division of Emergency Radiology (J.S., A.C., M.L.L., M.H.S.), Department of Psychiatry and Behavioral Sciences (M.L.L.), and Dominick P. Purpura Department of Neuroscience (M.L.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467; Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.); and Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (M.S., M.V.R.)
| | - Michael Spektor
- From the Department of Radiology, Division of Emergency Radiology (J.S., A.C., M.L.L., M.H.S.), Department of Psychiatry and Behavioral Sciences (M.L.L.), and Dominick P. Purpura Department of Neuroscience (M.L.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467; Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.); and Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (M.S., M.V.R.)
| | - Michael L. Lipton
- From the Department of Radiology, Division of Emergency Radiology (J.S., A.C., M.L.L., M.H.S.), Department of Psychiatry and Behavioral Sciences (M.L.L.), and Dominick P. Purpura Department of Neuroscience (M.L.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467; Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.); and Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (M.S., M.V.R.)
| | - Margarita V. Revzin
- From the Department of Radiology, Division of Emergency Radiology (J.S., A.C., M.L.L., M.H.S.), Department of Psychiatry and Behavioral Sciences (M.L.L.), and Dominick P. Purpura Department of Neuroscience (M.L.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467; Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.); and Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (M.S., M.V.R.)
| | - Meir H. Scheinfeld
- From the Department of Radiology, Division of Emergency Radiology (J.S., A.C., M.L.L., M.H.S.), Department of Psychiatry and Behavioral Sciences (M.L.L.), and Dominick P. Purpura Department of Neuroscience (M.L.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467; Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.); and Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (M.S., M.V.R.)
| |
Collapse
|
14
|
Abstract
Deep brain stimulation is now the most common surgical treatment of tremor. Tremor can be classified as action or resting tremor and is one of the most common movement disorders. Initial treatment of tremor should focus on medical treatment but, if patients fail medical therapy, deep brain stimulation should be considered with likely success. The usual target is the ventral intermediate nucleus of the thalamus. Common side effects of treatment include paresthesias, dysarthria, and less often ataxia. Future directions of research and development, including directional leads and closed-loop stimulation, may eventually lead to additional improvement in patient outcomes.
Collapse
Affiliation(s)
- Wendell Lake
- University of Wisconsin-Madison, 600 Highland Avenue, Box 8660, Madison, WI 53792, USA
| | - Peter Hedera
- Vanderbilt University Medical Center, 645 21st Avenue South, Nashville, TN 37240, USA
| | - Peter Konrad
- Vanderbilt University Medical Center, Room 4333, VAV, 1500 21st Avenue, Nashville, TN 37212, USA.
| |
Collapse
|
15
|
Whiting AC, Catapano JS, Walker CT, Godzik J, Lambert M, Ponce FA. Peri-Lead Edema After Deep Brain Stimulation Surgery: A Poorly Understood but Frequent Complication. World Neurosurg 2018; 124:S1878-8750(18)32915-2. [PMID: 30594699 DOI: 10.1016/j.wneu.2018.12.092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/13/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Postoperative peri-lead edema (PLE) is a poorly understood complication of deep brain stimulation (DBS), which has been described sporadically in patients presenting with profound and often delayed symptoms. We performed a prospective evaluation of patients undergoing DBS to determine the frequency of and identify risk factors for PLE. METHODS Patients underwent DBS electrode placement by a single physician. Postoperative magnetic resonance imaging (MRI) was performed approximately 6 weeks after the operation in asymptomatic subjects and analyzed for presence of PLE. All symptomatic subjects underwent MRI at the time of presentation. Data regarding index disease, preoperative medical issues, operative technique, and intraoperative variables were collected and statistically analyzed. RESULTS A total of 191 leads were placed in 102 subjects; 15 patients (14.7%) demonstrated PLE. Seven patients (6.9%) presented with symptoms related to PLE, most often altered mental status or neurologic deficit. Many of the MRI findings were profound, with PLE sometimes several centimeters in diameter. No statistically significant difference was found between PLE-positive and normal subjects when analyzing multiple variables, including presence of vascular disease, hypertension, anticoagulant/antiplatelet use, electrode target, index disease, unilateral versus bilateral lead placement, number of brain penetrations, and presence or absence of microelectrode recording. CONCLUSIONS Patients with postoperative PLE can present with severe symptoms or can be asymptomatic and go undiagnosed. Because of the delayed-onset potential, PLE may be more common than previously reported. No clear risk factors have been identified; therefore, further studies and increased clinical vigilance are paramount for improving comprehension and possible prevention of PLE.
Collapse
Affiliation(s)
- Alexander C Whiting
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Corey T Walker
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Margaret Lambert
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Francisco A Ponce
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
| |
Collapse
|
16
|
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: 25] [Impact Index Per Article: 4.2] [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.
Collapse
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
| |
Collapse
|
17
|
Nazzaro JM, Pahwa R, Lyons KE. Symptomatic, non-infectious, non-hemorrhagic edema after subthalamic nucleus deep brain stimulation surgery for Parkinson's disease. J Neurol Sci 2017; 383:42-46. [PMID: 29246619 DOI: 10.1016/j.jns.2017.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 11/17/2022]
Abstract
OBJECT We review our experience with Parkinson's disease (PD) patients who underwent subthalamic nucleus (STN) deep brain stimulation (DBS) and then developed noninfectious, non-hemorrhagic, delayed, symptomatic brain edema associated with a DBS lead. METHODS All PD patients who underwent STN DBS lead implantation from 2007 to 2015 were included. The same neurosurgeon performed all surgeries, typically in staged fashion, utilizing single pass microelectrode recordings (MER) within a stereotactic frame. A brain CT was obtained in recovery and subsequently if indicated. RESULTS There were 189 patients who underwent 363 STN lead implantations among which 35 (9.6%) represent re-implantations of removed leads in 28 (14.8%) patients. Among the 363 STN leads implanted, there were 12 (3.3%) cases of delayed symptomatic edema associated with a DBS lead involving 10 (5.3%) of the patients studied. Of the 328 leads representing first-time operations, there were 9 (2.1%) cases of delayed symptomatic edema in 7 (3.7%) patients, one of whom (14.3%) presented with seizures. For lead re-implantations, there were 3 (8.6%) cases of the brain edema in 3 (10.7%) patients; all presenting with seizures. For the 35 re-implantations, the trajectory to target was the same or very similar via the same burr hole as prior surgery in 17 (48.6%); 3 (17.6%) of whom developed edema. There was no case of brain edema in the 18 re-operated cases using a different burr opening. Edema patients were treated with a course of anticonvulsant medication and dexamethasone. Lead-associated edema resolved over generally a 4 to 6-week course. CONCLUSIONS Noninfectious, non-hemorrhagic, delayed, symptomatic brain edema occurs in approximately 3% of implanted leads and is more common in re-implantations (9%) compared to new implantations (2%). In re-implantations, the edema is more common when the same trajectory is used (18%) compared to a new trajectory (0%). The edema generally occurs 3 to 8 days after implantation, although immediate post-op CT is normal and seizures are a common presenting feature.
Collapse
Affiliation(s)
- Jules M Nazzaro
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kelly E Lyons
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
18
|
Zhang J, Wang T, Zhang CC, Zeljic K, Zhan S, Sun BM, Li DY. The safety issues and hardware-related complications of deep brain stimulation therapy: a single-center retrospective analysis of 478 patients with Parkinson's disease. Clin Interv Aging 2017; 12:923-928. [PMID: 28652714 PMCID: PMC5472429 DOI: 10.2147/cia.s130882] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Deep brain stimulation (DBS) is a well-established therapy for the treatment of advanced Parkinson's disease (PD) in patients experiencing motor fluctuations and medication-refractory tremor. Despite the relative tolerability and safety of this procedure, associated complications and unnatural deaths are still unavoidable. METHODS In this study, hardware-related complications and the causes of unnatural death were retrospectively analyzed in 478 patients with PD who were treated with DBS. RESULTS The results showed a 3-year survival rate of 98.6% and a 5-year survival rate of 96.4% for patients with PD who underwent DBS treatment at the study center. Pneumonia was the cause of death with the highest frequency. Prophylactic antibiotics and steroids or antihistamine drugs were adopted to reduce the risk of infection. Twenty-two patients (4.6%) experienced hardware-related complications. CONCLUSION Deaths of PD patients who receive DBS are typically unrelated to the disease itself or complications associated with the surgery. Pneumonia, malignant tumors, asphyxia, and multiple-organ failure are the common causes of death. Swallowing-related problems may be the most important clinical symptom in late-stage PD, as they cannot be stabilized or improved by DBS alone, and are potentially lethal. Although prophylactic antibiotics and steroids or antihistamine drugs may reduce the risk of infection, it is imperative to identify high-risk patients for whom a therapeutic approach not requiring an implantable device is more suitable, for example, pallidotomy and potentially transcranial ultrasound.
Collapse
Affiliation(s)
- Jing Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Tao Wang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Chen-Cheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Kristina Zeljic
- Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China
| | - Shikun Zhan
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Bo-Min Sun
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Dian-You Li
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| |
Collapse
|