Son Byung-Chul, Choi Jin-Gyu, Ha Sang-Woo
Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Asian J Neurosurg. 2018 Apr-Jun;13(2):407-410. doi: 10.4103/ajns.AJNS_148_16.
Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is an effective treatment for refractory epilepsy. Due to the unique location of ANT in the thalamus facing the lateral and third ventricles, transventricular DBS lead placement is an essential part of ANT DBS. However, there is no report regarding hardware problems including impedance variability in transventricular ANT DBS due to limited experience. A 45-year-old male patient with previously effective, bilateral ANT DBS presented with increasing seizure frequency and a shortened battery longevity within 2 years. Magnetic resonance imaging showed that the left-sided DBS lead was in the third ventricle leaning on the medial wall of ANT. Electrode revision was performed. Upon disconnecting the proximal lead from the extension connection, cerebrospinal fluid egress through fine gaps between the metallic electrode contacts, and electrode spacing was observed. This case raises a concern about the transventricular approach for ANT lead placement because the currently available DBS electrode lead is not waterproofed. A careful, longitudinal follow-up of DBS impedance for ANT DBS is warranted.
丘脑前核（ANT）的深部脑刺激（DBS）是治疗难治性癫痫的有效方法。由于ANT在丘脑的独特位置，其面向侧脑室和第三脑室，经脑室DBS电极植入是ANT DBS的重要组成部分。然而，由于经验有限，尚无关于经脑室ANT DBS硬件问题（包括阻抗变异性）的报道。一名45岁男性患者，之前接受双侧ANT DBS治疗有效，但在2年内癫痫发作频率增加且电池寿命缩短。磁共振成像显示左侧DBS电极位于第三脑室内，靠在ANT的内侧壁上。进行了电极修复。在将近端电极与延长连接断开后，观察到脑脊液通过金属电极触点之间的微小间隙流出以及电极间距。该病例引发了对ANT电极植入经脑室方法的担忧，因为目前可用的DBS电极导线不防水。有必要对ANT DBS的DBS阻抗进行仔细的长期随访。
