Whiting Alexander C, Catapano Joshua S, Walker Corey T, Godzik Jakub, Lambert Margaret, Ponce Francisco A
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
World Neurosurg. 2019 Apr;124:e340-e345. doi: 10.1016/j.wneu.2018.12.092. Epub 2018 Dec 28.
Postoperative peri-lead edema (PLE) is a poorly understood complication of deep brain stimulation (DBS), which has been described sporadically in patients presenting with profound and often delayed symptoms. We performed a prospective evaluation of patients undergoing DBS to determine the frequency of and identify risk factors for PLE.
Patients underwent DBS electrode placement by a single physician. Postoperative magnetic resonance imaging (MRI) was performed approximately 6 weeks after the operation in asymptomatic subjects and analyzed for presence of PLE. All symptomatic subjects underwent MRI at the time of presentation. Data regarding index disease, preoperative medical issues, operative technique, and intraoperative variables were collected and statistically analyzed.
A total of 191 leads were placed in 102 subjects; 15 patients (14.7%) demonstrated PLE. Seven patients (6.9%) presented with symptoms related to PLE, most often altered mental status or neurologic deficit. Many of the MRI findings were profound, with PLE sometimes several centimeters in diameter. No statistically significant difference was found between PLE-positive and normal subjects when analyzing multiple variables, including presence of vascular disease, hypertension, anticoagulant/antiplatelet use, electrode target, index disease, unilateral versus bilateral lead placement, number of brain penetrations, and presence or absence of microelectrode recording.
Patients with postoperative PLE can present with severe symptoms or can be asymptomatic and go undiagnosed. Because of the delayed-onset potential, PLE may be more common than previously reported. No clear risk factors have been identified; therefore, further studies and increased clinical vigilance are paramount for improving comprehension and possible prevention of PLE.
术后电极周围水肿（PLE）是一种人们了解甚少的深部脑刺激（DBS）并发症，在出现严重且往往延迟出现症状的患者中曾有过零星报道。我们对接受DBS治疗的患者进行了一项前瞻性评估，以确定PLE的发生率并识别其危险因素。
患者由同一位医生进行DBS电极植入。无症状受试者在术后约6周接受术后磁共振成像（MRI）检查，并分析是否存在PLE。所有有症状的受试者在就诊时均接受了MRI检查。收集有关索引疾病、术前医疗问题、手术技术和术中变量的数据，并进行统计分析。
共对102名受试者植入了191根电极；15名患者（14.7%）出现了PLE。7名患者（6.9%）出现了与PLE相关的症状，最常见的是精神状态改变或神经功能缺损。许多MRI检查结果都很严重，PLE有时直径达几厘米。在分析包括血管疾病、高血压、抗凝/抗血小板药物使用、电极靶点、索引疾病、单侧与双侧电极植入、脑穿透次数以及是否进行微电极记录等多个变量时，PLE阳性患者与正常受试者之间未发现统计学上的显著差异。
术后发生PLE的患者可能出现严重症状，也可能无症状而未被诊断出来。由于PLE可能有延迟发作的可能性，其实际发生率可能比之前报道的更高。目前尚未确定明确的危险因素；因此，进一步的研究以及提高临床警惕性对于更好地理解并可能预防PLE至关重要。
