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A Preventable Complication of Deep Brain Stimulation.

Published: June 8th, 2013

By: Michael Okun

Category: news, research

Dr. Foote and Dr. Morishita at the University of Florida Center for Movement Disorders and Neurorestoration published a paper this month that discusses a potentially preventable complication of deep brain stimulation: cerebral venous infarction.

Below is the abstract from the paper.

Neuromodulation. 2013 Jun 5. doi: 10.1111/ner.12052. [Epub ahead of print]

Cerebral Venous Infarction: A Potentially Avoidable Complication of Deep Brain Stimulation Surgery.

Source

Department of Neurosurgery, University of Florida College of Medicine/Shands Hospital, Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA.

Abstract

OBJECT:

Despite numerous reports on the morbidity and mortality of deep brain stimulation (DBS), cerebral venous infarction has rarely been reported. We present four cases of venous infarct secondary to DBS surgery.

METHODS:

The diagnosis of venous infarction was based on 1) delayed onset of new neurologic deficits on postoperative day 1 or 2; 2) significant edema surrounding the superficial aspect of the implanted lead, with or without subcortical hemorrhage on CT scan.

RESULTS:

Four cases (0.8% per lead, 1.3% per patient) of symptomatic cerebral venous infarction were identified out of 500 DBS lead implantation procedures between July 2002 and August 2009. All four patients had Parkinson’s disease. Their DBS leads were implanted in the subthalamic nucleus (n = 2), and the globus pallidus internus (n = 2). Retrospective review of the targeting confirmed that the planned trajectory passed within 3 mm of a cortical vein in two cases for which contrast-enhanced preoperative magnetic resonance (MR) imaging was available. In the other two cases, contrasted targeting images were not obtained preoperatively.

CONCLUSION:

Cerebral venous infarction is a potentially avoidable, but serious complication. To minimize its incidence, we propose the use of high-resolution, contrast-enhanced, T1-weighted MR images to delineate cerebral venous anatomy, along with careful stereotactic planning of the lead trajectory to avoid injury to venous structures.

© 2013 International Neuromodulation Society.

PMID:

 23738501

[PubMed – as supplied by publisher]

About the Author

Michael Okun

Professor of Neurology and Administrative Director of the Center for Movement Disorders and Neurorestoration

Professor of Neurology, expert on Parkinson's disease and other basal ganglia disorders, deep brain stimulation, author of over 300 research papers and the bestselling book Parkinson's Disease: 10 Secrets to a Happier…

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