Severe, Symptomatic, Self-limited Unilateral DBS Lead Edema Following Bilateral Subthalamic Nucleus Implantation

Gerard, Carter S.; Metman, Leo Verhagen; Pal, Gian; Karl, Jessica A.; Sani, Sepehr

doi:10.1097/nrl.0000000000000082

Cited by 7 publications

(11 citation statements)

References 17 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.…”

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%

“…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%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…Previous surgical interventions in symptomatic patients with peri-lead edema and cysts have included lumbar puncture, fluid tap from the surgical site, cyst aspiration, and lead removal, typically yielding no evidence of infection [4, 10]. In addition to preventing unnecessary interventions, increased awareness of this pathology will allow us to improve our study of the etiology and relevance of this rare complication.…”

Section: Discussionmentioning

confidence: 99%

Acute symptomatic peri-lead edema 33 hours after deep brain stimulation surgery: a case report

et al. 2017

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BackgroundSymptomatic peri-lead edema is a rare complication of deep brain stimulation that has been reported to develop 4 to 120 days postoperatively.Case presentationHere 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.ConclusionsWe 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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Fulminant non-infectious peri-electrode edema after deep brain stimulation system implantation in a pediatric patient

2021

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Severe, Symptomatic, Self-limited Unilateral DBS Lead Edema Following Bilateral Subthalamic Nucleus Implantation

Abstract: Lead edema is a rare complication after DBS surgery. It is important to recognize the benign clinical course of DBS lead edema to counsel patients and avoid unnecessary treatment such as hardware removal.

Cited by 7 publications

References 17 publications

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

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

Acute symptomatic peri-lead edema 33 hours after deep brain stimulation surgery: a case report

Fulminant non-infectious peri-electrode edema after deep brain stimulation system implantation in a pediatric patient

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