Son Byung-Chul, Kim Joong-Seok, Park Woo-Chan, Ko Hak-Cheol
Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, the Republic of Korea.
Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, the Republic of Korea.
J Neurol Surg A Cent Eur Neurosurg. 2019 May;80(3):223-227. doi: 10.1055/s-0038-1677518. Epub 2019 Feb 1.
Although deep brain stimulation (DBS) has been used for > 25 years in the treatment of movement disorders, no report has been published on the management of DBS pulse generators implanted in the anterior chest in patients with breast cancer who require mastectomy, radiotherapy, and future imaging studies.We describe a 62-year-old female patient with advanced Parkinson's disease (PD) who was dependent on bilateral subthalamic nucleus (STN) DBS. She was diagnosed with cancer in her left breast. To avoid difficulties in imaging studies, surgery, and radiotherapy related to the breast cancer, bilateral pulse generators for STN DBS previously implanted in the anterior chest wall were repositioned to the anterior abdominal wall with replacement of long extension cables. During mastectomy and the relocation of the pulse generators, we were not aware of the risks of an open circuit and neuroleptic malignant-like syndrome due to our limited knowledge about how to manage DBS hardware.Coincident breast cancer and the need for STN DBS is underreported. Considering the uncertainties in the management of pulse generators and the incidence of breast cancer, guidelines for handling DBS hardware in the setting of cancer are needed. More careful attention should be paid to performing magnetic resonance imaging in DBS-dependent patients with chronic PD.
尽管深部脑刺激（DBS）已用于治疗运动障碍超过25年，但对于需要进行乳房切除术、放疗及未来影像学检查的乳腺癌患者，尚未有关于植入前胸的DBS脉冲发生器管理的报告发表。我们描述了一名62岁的晚期帕金森病（PD）女性患者，她依赖双侧丘脑底核（STN）DBS治疗。她被诊断出左乳患有癌症。为避免与乳腺癌相关的影像学检查、手术及放疗困难，先前植入前胸壁的双侧STN DBS脉冲发生器被重新放置到前腹壁，并更换了长的延长电缆。在乳房切除术及脉冲发生器重新定位过程中，由于我们对如何管理DBS硬件的知识有限，并未意识到开路和类神经安定性恶性综合征的风险。乳腺癌与STN DBS需求并存的情况报道较少。考虑到脉冲发生器管理的不确定性及乳腺癌的发病率，需要制定在癌症背景下处理DBS硬件的指南。对于依赖DBS的慢性PD患者，进行磁共振成像时应更加谨慎。
