Idiopathic delayed-onset edema surrounding deep brain stimulation leads: Insights from a case series and systematic literature review

Cuba, Catherine M.K.E. de; Albanese, Alberto; Antonini, Angelo; Cossu, Giovanni; Deuschl, Günther; Eleopra, Roberto; Galati, Alejandro; Hoffmann, C.F.E.; Knudsen, Karina; Landi, Andrea; Lanotte, Michele; Marcante, Andrea; Mosch, Arne; Pilleri, Manuela; Reich, Martin M.; Ricchi, Valeria; Rinaldo, Sara; Romito, Luigi; Saba, F; Sacristan, Horacio E.; Schuurman, P. Richard; Trezza, Andrea; Munckhof, Pepijn van den; Volkmann, Jens; Zibetti, Maurizio; Contarino, Maria Fiorella

doi:10.1016/j.parkreldis.2016.09.007

Cited by 29 publications

(44 citation statements)

References 30 publications

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“…In past years other authors have described radiological findings consistent with peri‐electrode edema in patients following DBS lead placement . The literature indicates an extremely wide range from 0.4% to 39% for this complication. We speculate that this broad variability may be explained by two main reasons: (i) the timing between the surgical procedure and the neuroimaging, and (ii) the different sensitivity of MRI and CT scans in detecting vasogenic edema in the presence of the lead artifact.…”

Section: Discussionmentioning

confidence: 94%

“…Of the 19 patients who underwent post-operative MRI, seven were female and 12 were male. Mean age at the time of surgery was 58 AE 7.9 (range 42-70) years, with a mean disease duration of 13 AE 3.1 (range [8][9][10][11][12][13][14][15][16][17] years.…”

Section: Resultsmentioning

confidence: 99%

“…The most frequently reported complications include hemorrhage, infection and hardware failure [1]. In recent years, non-infectious, delayed-onset post-operative cerebral edema around DBS electrodes has been reported as a rare complication of DBS surgery by different groups worldwide [2][3][4][5][6][7][8][9][10][11][12][13]. According to the literature, its incidence ranges from 0.4% [10] to 39% [2], but methods for its detection are heterogeneous, including studies of computed tomography (CT) and magnetic resonance imaging (MRI) performed only in selected patients and at different time intervals after surgery.…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, non-infectious, delayed-onset post-operative cerebral edema around DBS electrodes has been reported as a rare complication of DBS surgery by different groups worldwide [2][3][4][5][6][7][8][9][10][11][12][13]. According to the literature, its incidence ranges from 0.4% [10] to 39% [2], but methods for its detection are heterogeneous, including studies of computed tomography (CT) and magnetic resonance imaging (MRI) performed only in selected patients and at different time intervals after surgery. Most studies report post-operative edema as a symptomatic complication [3,[5][6][7][8][9][10][11]13], whereas others find it accidentally during routine imaging in asymptomatic patients [2,4,12].…”

Section: Introductionmentioning

confidence: 99%

“…According to the literature, its incidence ranges from 0.4% [10] to 39% [2], but methods for its detection are heterogeneous, including studies of computed tomography (CT) and magnetic resonance imaging (MRI) performed only in selected patients and at different time intervals after surgery. Most studies report post-operative edema as a symptomatic complication [3,[5][6][7][8][9][10][11]13], whereas others find it accidentally during routine imaging in asymptomatic patients [2,4,12]. The true prevalence of this entity is still unknown as no control MRI is routinely performed in the days after DBS surgery.…”

Section: Introductionmentioning

confidence: 99%

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Peri‐lead edema after deep brain stimulation surgery for Parkinson's disease: a prospective magnetic resonance imaging study

Borellini

Ardolino

Carrabba

et al. 2018

Euro J of Neurology

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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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Section: Discussionmentioning

confidence: 94%