Mori Fumi, Yoshida Koichiro, Watanabe Mitsuru, Kobayashi Kazutaka, Fukaya Chikashi, Oshima Hideki, Yoshino Atsuo
Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine.
No Shinkei Geka. 2019 Jul;47(7):785-791. doi: 10.11477/mf.1436204023.
We report a rare complication in a patient with Parkinson's disease who underwent deep brain stimulation(DBS)surgery. The patient was a 60-year-old woman who presented with frontal lobe signs, including ataxic gait and memory disturbance, that were caused by the unexpected migration of a burr hole cap into the brain three to four months after surgery. The patient had no incidence of a head injury prior to development of symptoms. The patient underwent surgery to extract the migrated cap from the frontal lobe, and her symptoms improved several months after the operation. The cap serves to fix the DBS lead to the skull using an adjunctive burr hole ring. It was intraoperatively confirmed that only the cap detached from the ring, and no cap or ring defects were detected in a postoperative quality check by the manufacturer. We have previously utilized a burr hole ring and cap, which are packaged along with the DBS electrode, when employing the product made by Medtronic Inc. No previous report has described the cap packed in the official DBS kit to have migrated into the intracranial space. It seems unlikely that the cap migration into the intracranial space would occur without the cap and/or ring breaking through either traumatic injury or from manufacturing defects. It is important to consider the migration of a burr hole cap into the intracranial space in the absence of head injury as a possible device complication after DBS surgery.
我们报告了一例帕金森病患者在接受脑深部电刺激（DBS）手术后出现的罕见并发症。该患者为一名60岁女性，术后三到四个月，由于一个钻孔帽意外移入脑内，出现了额叶体征，包括共济失调步态和记忆障碍。在症状出现之前，患者没有头部受伤史。患者接受了手术，从额叶取出移位的帽，术后几个月症状有所改善。该帽用于通过辅助钻孔环将DBS导线固定在颅骨上。术中确认只有帽从环上脱落，制造商在术后质量检查中未检测到帽或环有缺陷。我们以前在使用美敦力公司生产的产品时，使用过与DBS电极一起包装的钻孔环和帽。以前没有报告描述过官方DBS套件中包装的帽移入颅内空间的情况。如果没有帽和/或环因外伤或制造缺陷而破裂，帽移入颅内空间似乎不太可能发生。在没有头部受伤的情况下，考虑钻孔帽移入颅内空间是DBS手术后可能出现的一种器械并发症，这一点很重要。
