Objective: To report a rare case of acute laryngospasm during intraoperative stimulation in VIM-DBS surgery.

Background: Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) is established for medically refractory essential tremor. Awake surgery allows intraoperative assessment, but respiratory complications are extremely rare.

Method: We retrospectively reviewed the perioperative course of a patient undergoing staged bilateral VIM-DBS. Clinical findings, intraoperative electrophysiology, stimulation parameters, imaging, and postoperative cardiopulmonary evaluations were analyzed.

Results: A 62-year-old man with refractory essential tremor underwent left VIM-DBS. Targeting used stereotactic MRI/CT and microelectrode recordings (MER). Five microelectrodes were implanted; neuronal activity from −10 mm to +3 mm relative to target confirmed VIM localization. Macrostimulation on the central trajectory at −1 mm, 130 Hz, 60 μs, up to 4 mA caused mild dysarthria. During on–off testing, the patient developed inspiratory stridor, progressing to acute respiratory distress despite stimulation withdrawal. No evidence of upper airway edema was noted and the patient remained conscious. No cardiac or hemodynamic abnormalities were present; oxygen desaturation occurred only after cyanosis onset. Airway support and curare enabled fiberoptic intubation. Postoperative brain and thoracic CT were normal. The patient fully recovered after sedation withdrawal and was discharged without sequelae.

Conclusion: This case highlights a rare, potentially life-threatening complication during awake VIM-DBS. Acute laryngospasm occurred immediately after stimulation suggesting a functional, stimulation-induced mechanism. Possible explanations include current spread to corticobulbar fibers controlling laryngeal muscles or activation of thalamic networks regulating respiratory and laryngeal reflexes. Evidence shows thalamic nuclei can modulate vagally mediated laryngeal reflexes via brainstem projections, potentially explaining sudden airway closure. Alternative, more common causes, such as airway irritation or aspiration were excluded. Awareness of this rare complication is essential for awake DBS, as rapid recognition and airway management are critical. This report adds to the literature by describing intraoperative laryngospasm during VIM-DBS for essential tremor, a phenomenon not previously documented.

Postoperative brain CT DBS electrode trajectory.

VIM Intraoperative microelectrode recordings

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MDS Abstracts - https://www.mdsabstracts.org/abstract/stimulation-induced-laryngospasm-during-awake-ventral-intermediate-nucleus-deep-brain-stimulation-for-essential-tremor/