Staudt Michael D, MacDougall Keith W
Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada.
Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada.
World Neurosurg. 2018 Sep;117:249-254. doi: 10.1016/j.wneu.2018.06.115. Epub 2018 Jun 22.
The development of an intraparenchymal cyst following deep brain stimulation (DBS) surgery is an uncommon complication that lacks a clearly defined management strategy. The pathophysiology is not known and may be related to perielectrode edema or cerebrospinal fluid tracking. Previous case reports have described various therapies for symptomatic cysts, including hardware removal or conservative treatment with steroids.
We present a male patient with bilateral DBS of the ventral intermediate nucleus of the thalamus for management of essential tremor, who developed a cystic cavitation at the left electrode tip and was followed without treatment. This patient developed dysarthria, gait impairment, and unilateral motor deficits 3 months after surgery. Perielectrode edema was initially identified, eventually coalescing into a cystic cavitation at the electrode tip. Cystic regression and symptomatic improvement were observed without any surgical or medical intervention, with full cyst resolution by 17 months.
Only 15 additional cases have been reported in the literature, although the true incidence may be underreported because of varying practices in obtaining postoperative scans. Cysts were identified in symptomatic patients on average 6.2 months after surgery. All symptomatic cysts were treated with hardware removal or steroid therapy. Observation alone may be sufficient when a DBS-associated cyst is identified. More reports are needed to characterize this rare complication.
脑深部电刺激（DBS）手术后脑实质内囊肿的形成是一种罕见的并发症，目前尚无明确的管理策略。其病理生理学尚不清楚，可能与电极周围水肿或脑脊液追踪有关。既往病例报告描述了针对有症状囊肿的各种治疗方法，包括取出硬件或用类固醇进行保守治疗。
我们报告一名男性患者，因原发性震颤接受双侧丘脑腹中间核DBS治疗，该患者在左电极尖端出现囊性空洞，未接受治疗并进行随访。该患者在术后3个月出现构音障碍、步态障碍和单侧运动功能缺损。最初发现电极周围水肿，最终在电极尖端合并形成囊性空洞。在未进行任何手术或药物干预的情况下，观察到囊肿消退且症状改善，至17个月时囊肿完全消失。
文献中仅另外报道了15例病例，尽管由于术后扫描的做法不同，实际发病率可能报告不足。有症状患者的囊肿平均在术后6.2个月被发现。所有有症状的囊肿均采用取出硬件或类固醇治疗。当发现与DBS相关的囊肿时，仅观察可能就足够了。需要更多报告来描述这种罕见并发症。
