Article
Frequency and risk factors for postoperative symptomatic or asymptomatic edema surrounding the leads for chronic deep brain stimulation
Postoperative Hypodensitäten als Reaktion auf Elektrodenimplantationen bei tiefen Hirnstimulationseingriffen: eine Untersuchung an 61 Patienten
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Authors
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Thomas Kriesen
- Universitätsmedizin Rostock, Klinik und Poliklinik für Neurochirurgie, Rostock, Deutschland
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Matthias Löhle
- Universitätsmedizin Rostock, Neurology, Rostock, Deutschland
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René Reese
- Universitätsmedizin Rostock, Neurology, Rostock, Deutschland
| Published: | May 25, 2022 |
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Outline
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Objective: The implantation of electrodes into basal ganglia nuclei for deep brain stimulation (DBS) has become a routine technique in the treatment of movement disorders. Postoperative CT- or MRI-imaging to verify correct lead placement and to exclude surgical complications may show edema around the implanted electrodes from cortical entry to subcortical regions either clinically asymptomatic or symptomatic. The knowledge of risk factors and pathomechanisms of such edema is mandatory as symptomatic edema may lead to prolonged postoperative recovery and hospitalization.
Methods: We quantified eventual intracerebral edema on day 0 or day 1 postoperatively determined CT- or MRI-scans in 61 consecutive movement disorders patients implanted with DBS electrodes in our department. The implanted lead type (manufacturer, ring or directional electrodes), surgical incidents, total operating time, brain side for initial lead implantation and the number of microelectrodes used for evaluation of the target region were hypothesized as potential risk factors for postoperative edema.
Results: In all patients, leads and DBS systems were implanted without intraoperative incidents. In 14 of 61 patients (23%) postoperative edema was detected in postoperative CT- and /or MRI-scans. Operating time, brain side for initial implantation, and the number of microelectrodes did not differ to the patient group without peri-lead intracerebral edema. Edema occurred with directional more frequent as conventional ring electrodes. The maximum of edema volume was about 5 cc (range 0.3 to 19.6 cc) mostly manifesting unilaterally. 25% of the patients with edema were symptomatic showing apathy and reduced alertness resulting in prolonged recovery and hospitalization but were still symptomatic at day of discharge from the hospital. Some patients received dexamethasone. All edema were self- limiting in control images.
Conclusion: In our small monocentric patient cohort, transient postoperative symptomatic intracerebral peri-lead edema after basal ganglia implantation of electrodes for DBS in movement disorders was of relatively small frequency but clinically relevant due to potentially harmful symptoms and prolonged hospitalization. A specific risk factor could be directional leads. This should be investigated in larger cohorts for further verification.
