Session Time: 1:45pm-3:15pm
Location: Hall 3FG
Objective: The purpose of our study is to define the incidence and the magnetic resonance imaging (MRI) characteristics of peri-electrode edema in a cohort of patients undergoing deep brain stimulation (DBS) surgery and to correlate it with clinical findings.
Background: In the past recent years, non-infectious, delayed-onset postoperative cerebral edema around DBS elcetrode has been reported as a rare complication of DBS surgery by different groups worldwide (1). According to the literature the incidence ranges from 0.4% (1) to 39% (2), but methods for its detection are heterogeneous, mostly based on early post-operative computed tomography (CT) scans.
Methods: The present is a prospective observational study involving all patients who underwent DBS surgery at our Centre from March 2017 to February 2018. All patients underwent at least a post-operative CT scan and, from 6 to 20 days after surgery, a brain MRI. In a subgroup of patients a follow-up MRI was performed 22 to 56 days after the operation. The volume of the T2-weighted hyperintensity surrounding each DBS lead was quantified by one radiologist using a semi-automatic volume segmentation method. Likewise we described the main distribution of edema along the lead, differentiating between peripheral and deep edema. Any evidence of bleeding around the lead was also evaluated and collected. Daily clinical and follow up data were collected.
Results: 18 patients, all undergoing bilateral subthalamic nucleus DBS for PD, were enrolled. Post-operative CT was negative in all patients. The first MRI showed the presence of a various degree of edematous reaction in all (100%) patients (mean 23.2 ml, range 2.85-71.2 ml), which was unilateral only in 3 patients (17%) and bilateral in the others. In 5 patients (28%) MRI detected also minor haemorrhagic collection around one of the two electrodes. Only one of these patients was symptomatic, presenting with a moderate confusional state. In the 9 patients with a follow up MRI, edema completely resolved only in the 7 patients whose MRI was performed more than 30 days after surgery, in the others it was still present but markedly reduced. We did not find any significant correlation between edema volume, distribution and any clinical feature: most patients were asymptomatic. Only 5 of them developed a transient confusional state (28%), which significantly correlated to age but not to any MRI feature.
Conclusions: Our results suggest that peri-electrode edema is a common, transient and benign reaction to DBS lead placement and that its detection is strictly dependent on the timing of imaging.
References: (1) de Cuba CM, Albanese A, Antonini A, Cossu G, Deuschl G, Eleopra R, Galati A, Hoffmann CF, Knudsen K, Landi A, Lanotte MM, Marcante A, Mosch A, Pilleri M, Reich MM, Ricchi V, Rinaldo S, Romito LM, Saba FS, Sacristan HE, Schuurman, Trezza, van den Munckhof P, Volkmann J, Zibetti M, Contarino. Idiopathic delayed-onset edema surrounding deep brain stimulation leads: Insights from a case series and systematic literature review. Parkinsonism Relat Disord. 2016 Nov;32:108-115. doi: 10.1016/j.parkreldis.2016.09.007. Epub 2016 Sep 6. (2) 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(2-3):65-9. Epub 2004 Mar 19.
To cite this abstract in AMA style:L. Borellini, F. Cogiamanian, S. Sbaraini, E. Scola, G. Carrabba, M. Locatelli, S. Avignone, F. Mameli, F. Ruggiero, R. Ferrucci, G. Ardolino, S. Barbieri, P. Rampini. A prospective MRI study of edema surrounding deep brain stimulation leads [abstract]. Mov Disord. 2018; 33 (suppl 2). https://www.mdsabstracts.org/abstract/a-prospective-mri-study-of-edema-surrounding-deep-brain-stimulation-leads/. Accessed December 1, 2023.
« Back to 2018 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/a-prospective-mri-study-of-edema-surrounding-deep-brain-stimulation-leads/