Deep brain stimulation complicated by bilateral large cystic cavitation around the leads in a patient with Parkinson's disease

Abstract

This therapy is, rarely, associated with complications, mostly related to infections, seizures or stimulationinduced side effects. We report a case of a 71-year-old man with a 10-year history of PD who underwent bilateral placement of subthalamic nucleus DBS. As a complication, the patient showed subjective postoperative cognitive decline, and subsequent MRI showed peri-lead oedema, which progressed to large cystic cavitation around the leads without indication of infection. The patient received steroid therapy and the cavitations regressed without surgical intervention. BACKGROUND

Acute and Subacute Presentations of Cerebral Edema following Deep Brain Stimulation Lead Implantation

“…We agree with the management algorithm as proffered by others [1,2,4] that steroid therapy is the best treatment to render. However, in acute postoperative presentations, oftentimes in the intensive care unit setting, the neurosurgeon is but one component of a larger multidisciplinary team that provides critical care.…”

“…Although there have been multiple case reports and limited series in the literature [1,2,3,4,5] of such postoperative edematous cases, it remains an intriguing complication of which true etiology is unknown and is distinct from other more common complications such as hemorrhage, infection, or hardware-related issues that have been very well reported and characterized [6,7,8,9,10]. As described in the other reports [1,2,3,4,5], presentation is variable and independent of the underlying diagnosis or target. …”

“…Noninfectious, self-limiting postoperative cerebral edema around a deep brain stimulation (DBS) electrode is an uncommon complication infrequently reported in the medical literature [1,2,3,4,5]. The etiology of this clinical scenario remains unknown and is distinct from other more common complications such as hemorrhage, infection, or hardware-related issues that have been very well reported and characterized [6,7,8,9,10].…”

“…The etiology of this clinical scenario remains unknown and is distinct from other more common complications such as hemorrhage, infection, or hardware-related issues that have been very well reported and characterized [6,7,8,9,10]. Occurrence and presentation of symptoms vary, from subtle behavioral changes to lethargy and hemiplegia, presenting a few days postoperatively to several months later [1,2,3,4,5]. Imaging description and diagnosis also vary depending on the modality chosen, associated with increased T2 hyperintensity on MRI [2], contrast enhancement [5], or cystic cavitation on CT [4].…”

“…Occurrence and presentation of symptoms vary, from subtle behavioral changes to lethargy and hemiplegia, presenting a few days postoperatively to several months later [1,2,3,4,5]. Imaging description and diagnosis also vary depending on the modality chosen, associated with increased T2 hyperintensity on MRI [2], contrast enhancement [5], or cystic cavitation on CT [4]. …”