U.O. Neurofisiopatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
U.O. Neurochirurgia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
Eur J Neurol. 2019 Mar;26(3):533-539. doi: 10.1111/ene.13852. Epub 2018 Nov 18.
The aim of this study was to define the prevalence and characteristics of peri-electrode edema in a prospective cohort of patients undergoing deep brain stimulation (DBS) surgery and to correlate it with clinical findings.
We performed brain magnetic resonance imaging (MRI) between 7 and 20 days after surgery in 19 consecutive patients undergoing DBS surgery for Parkinson's disease. The T2-weighted hyperintensity surrounding DBS leads was characterized and quantified. Any evidence of bleeding around the leads was also evaluated. Clinical and follow-up data were recorded. In a subgroup of patients, a follow-up MRI was performed 3-6 weeks after surgery. We also retrospectively reviewed the post-operative computed tomography scans of patients who underwent DBS at our center since 2013.
Magnetic resonance imaging showed a peri-lead edematous reaction in all (100%) patients, which was unilateral in three patients (15.8%). In six patients (31.6%), we detected minor peri-lead hemorrhage. Edema completely resolved in eight out of 11 patients with a follow-up MRI and was markedly reduced in the others. Most patients were asymptomatic but six (31.6%) manifested various degrees of confusional state without motor symptoms. We found no significant correlation between edema volume, distribution and any clinical feature, including new post-operative neurological symptoms. The retrospective computed tomography analysis showed that peri-electrode hypodensity consistent with edema is absent at early post-operative imaging but is common at scans performed >3 days after surgery.
Peri-electrode edema is a common, transient reaction to DBS lead placement and a convincing relation between edema and post-operative clinical status is lacking.
本研究旨在明确接受深部脑刺激（DBS）手术的患者中，电极周围水肿的发生率和特点，并与临床发现相关联。
我们对 19 例行 DBS 手术治疗帕金森病的连续患者，在术后 7-20 天内行脑磁共振成像（MRI）检查。对 DBS 导联周围的 T2 加权高信号进行了特征描述和量化，并评估了任何导联周围出血的证据。记录了临床和随访数据。在部分患者中，在术后 3-6 周行 MRI 随访。我们还回顾性分析了自 2013 年以来在我们中心接受 DBS 治疗的患者的术后 CT 扫描。
MRI 显示所有（100%）患者均存在导联周围水肿反应，其中 3 例（15.8%）为单侧。在 6 例（31.6%）患者中，我们检测到轻微的导联周围出血。11 例中有 8 例在接受 MRI 随访时，水肿完全消退，其余患者水肿明显减轻。大多数患者无症状，但 6 例（31.6%）出现不同程度的意识模糊，无运动症状。我们发现水肿体积、分布与任何临床特征（包括新的术后神经症状）之间无显著相关性。回顾性 CT 分析显示，术后早期影像学未见电极周围与水肿一致的低信号，但术后 >3 天的扫描中很常见。
电极周围水肿是 DBS 导联放置后的常见、短暂反应，与术后临床状态之间缺乏令人信服的关系。
