Morishita Takashi, Okun Michael S, Burdick Adam, Jacobson Charles E, Foote Kelly D
Department of Neurosurgery, University of Florida College of Medicine/Shands Hospital, Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA.
Neuromodulation. 2013 Sep-Oct;16(5):407-13; discussion 413. doi: 10.1111/ner.12052. Epub 2013 Jun 5.
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.
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.
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.
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.
尽管有大量关于脑深部电刺激（DBS）发病率和死亡率的报道，但脑静脉梗死却鲜有报告。我们报告4例DBS手术后继发的静脉梗死病例。
静脉梗死的诊断基于：1）术后第1天或第2天出现新的神经功能缺损延迟发作；2）植入电极浅表部位周围有明显水肿，CT扫描有无皮质下出血。
在2002年7月至2009年8月期间的500例DBS电极植入手术中，发现4例（每根电极0.8%，每名患者1.3%）有症状的脑静脉梗死。所有4例患者均患有帕金森病。他们的DBS电极植入了丘脑底核（n = 2）和内侧苍白球（n = 2）。对靶点的回顾性分析证实，在有术前对比增强磁共振（MR）成像的2例中，计划的轨迹在距皮质静脉3毫米内通过。在另外2例中，术前未获得对比靶点图像。
脑静脉梗死是一种潜在可避免但严重的并发症。为了将其发生率降至最低，我们建议使用高分辨率、对比增强的T1加权MR图像来描绘脑静脉解剖结构，并仔细进行电极轨迹的立体定向规划，以避免损伤静脉结构。
