Background/Aims: Postoperative cerebral edema around a deep brain stimulation (DBS) electrode is an uncommon reported complication. The goal of this study was to identify instances of postoperative edema based on clinical presentation, and to remark on their management. Methods: A retrospective chart review was performed on all patients who underwent DBS electrode implantation over a 3-year period. Routine CT imaging on postoperative day (POD) 1 was negative. Patients were identified based on clinical neurological changes, leading to imaging and subsequent diagnosis. Results: Five of 145 patients (3.4%) presented with new neurological symptoms from POD 1 to 14, which were confirmed by CT imaging to show perilead and/or subcortical edema around 6 of 281 electrodes (2.1%). Four of 5 patients had unilateral edema despite bilateral implantation. Clinical presentations varied widely. Two patients presenting on POD 1 with deteriorating conditions required longer inpatient stays with supportive measures than those presenting later (p = 0.0002). All patients were treated with corticosteroids and returned to baseline by 3 months after surgery. Conclusions: Acute instances of DBS lead edema may occur as early as POD 1 and can rapidly progress into profound deficits. Treatment with supportive care and corticosteroids is otherwise identical to those cases presenting later.

1.
Deogaonkar M, Nazarro JM, Machado A, Rezai A: Transient, symptomatic, post-operative, non-infectious hypodensity around the deep brain stimulation (DBS) electrode. J Clin Neurosci 2011;18:910-915.
2.
Englot DJ, Glastonbury CM, Larson PS: Abnormal T2-weighted MRI signal surrounding leads in a subset of deep brain stimulation patients. Stereotact Funct Neurosurg 2011;89:311-317.
3.
Lefaucheur R, Derrey S, Borden A, Wallon D, Ozkul O, Gérardin E, Maltête D: Post-operative edema surrounding the electrode. Brain Stimul 2013;6:459-460.
4.
Jagid J, Madhavan K, Bregy A, Desai M, Ruiz A, Quencer R, Landy HJ: Deep brain stimulation complicated by bilateral large cystic cavitation around the leads in a patient with Parkinson's disease. BMJ Case Rep DOI: 10.1136/bcr-2015-211470.
5.
Arocho-Quinones EV, Pahapill PA: Non-infectious peri-electrode edema and contrast enhancement following deep brain stimulation surgery. Neuromodulation DOI: 10.1111/ner.12432.
6.
Fenoy AJ, Simpson RK Jr: Management of device-related wound complications in deep brain stimulation surgery. J Neurosurg 2012;116:1324-1332.
7.
Fenoy AJ, Simpson RK Jr: Risks of common complications in deep brain stimulation surgery: management and avoidance. J Neurosurg 2014;120:132-139.
8.
Voges J, Waerzeggers Y, Maarouf M, Lehrke R, Koulousakis A, Lenartz D, Sturm V: Deep-brain stimulation: long-term analysis of complications caused by hardware and surgery - experiences from a single centre. J Neurol Neurosurg Psychiatry 2006;77:868-872.
9.
Beric A, Kelly PJ, Rezai A, Sterio D, Mogilner A, Zonenshayn M, et al: Complications of deep brain stimulation surgery. Stereotact Funct Neurosurg 2001;77:73-78.
10.
Umemura A, Jaggi JL, Hurtig HI, Siderowf AD, Colcher A, Stern MB, Baltuch GH: Deep brain stimulation for movement disorders: morbidity and mortality in 109 patients. J Neurosurg 2003;98:779-784.
11.
Nakase H, Shin Y, Nakagawa I, Kimura R, Sakaki T: Clinical features of postoperative cerebral venous infarction. Acta Neurochir (Wien) 2005;147:621-626; discussion 626.
12.
Ryu SI, Romanelli P, Heit G: Asymptomatic transient MRI signal changes after unilateral deep brain stimulation electrode implantation for movement disorder. Stereotact Funct Neurosurg 2004;82:65-69.
13.
Go KG: The normal and pathological physiology of brain water. Adv Tech Stand Neurosurg 1997;23:47-142.
14.
Huk WJ, Gademann G: Magnetic resonance imaging (MRI): method and early clinical experiences in diseases of the central nervous system. Neurosurg Rev 1984;7:259-280.
15.
Henderson JM, Pell M, O'Sullivan DJ, McCusker EA, Fung VS, Hedges P, Halliday GM: Postmortem analysis of bilateral sub-thalamic electrode implants in Parkinson's disease. Mov Disord 2002;17:133-137.
16.
Louveau A, Smirnov I, Keyes TJ, Eccles JD, Rouhani SJ, Peske JD, Derecki NC, Castle D, Mandell JW, Lee KS, Harris TH, Kipnis J: Structural and functional features of central nervous system lymphatic vessels. Nature 2015;523:337-341.
17.
Louveau A, Harris TH, Kipnis J: Revisiting the mechanisms of CNS immune privilege. Trends Immunol 2015;36:569-577.
18.
Wood H: Neuroimmunology: uncovering the secrets of the “brain drain” - the CNS lymphatic system is finally revealed. Nat Rev Neurol 2015;11:367.
19.
Aspelund A, Antila S, Proulx ST, Karlsen TV, Karaman S, Detmar M, Wiig H, Alitalo K: A dural lymphatic vascular system that drains brain interstitial fluid and macromolecules. J Exp Med 2015;212:991-999.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.