Sharma Vibhash D, Lyons Kelly E, Nazzaro Jules M, Pahwa Rajesh
Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America.
Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America.
J Neurol Sci. 2020 Mar 15;410:116647. doi: 10.1016/j.jns.2019.116647. Epub 2019 Dec 25.
Post-operative, non-hemorrhagic, non-infectious symptomatic delayed edema around the DBS lead is an uncommon complication of DBS surgery. We investigated whether this complication impacts clinical outcomes or has long-term sequelae.
All Parkinson's disease (PD) patients with subthalamic nucleus (STN) DBS implantation who developed delayed symptomatic lead edema were identified. UPDRS part III motor, Parkinson's Disease Questionnaire (PDQ-39) total and MoCA scores were analyzed to assess motor outcome, quality of life and cognitive status at 1 year.
A total of 260 patients underwent 482 STN lead placements. Of these, 16 patients (20 leads, 4.1% of total 482 leads) developed this delayed complication. None of the patients had edema on immediate post-operative scan. Patients presented with varied symptoms including speech difficulty (n = 8), mild confusion (n = 6), headaches (n = 4), gait difficulty (n = 4) and seizures (n = 3). The mean duration for the diagnosis was 5.8 days after lead implantation and the mean duration for which follow-up CT scans reported complete/near complete resolution or improvement of edema was 4.7 weeks (range 2-10 weeks). At 1-year post-DBS, UPDRS motor scores improved significantly (42.5%, p < .001); quality of life improved, but the change was not statistically significant (21.3%, p = .197). There was no decline in cognitive function at 1 year (26.6 vs 26.4, p = .567). No long-term complication related to lead edema occurred in these patients.
Symptomatic lead edema after DBS surgery is an uncommon complication which typically resolves over time. In our series, there were no long-term sequelae of this complication and clinical outcomes were comparable to that reported in the literature.
脑深部电刺激（DBS）电极周围术后非出血性、非感染性症状性延迟水肿是DBS手术一种罕见的并发症。我们研究了这种并发症是否会影响临床结局或产生长期后遗症。
确定所有接受丘脑底核（STN）DBS植入术且出现延迟症状性电极水肿的帕金森病（PD）患者。分析统一帕金森病评定量表（UPDRS）第三部分运动评分、帕金森病问卷（PDQ-39）总分和蒙特利尔认知评估量表（MoCA）评分，以评估1年时的运动结局、生活质量和认知状态。
共有260例患者接受了482次STN电极植入。其中，16例患者（20根电极，占482根电极总数的4.1%）出现了这种延迟并发症。所有患者术后即刻扫描均未出现水肿。患者出现多种症状，包括言语困难（n = 8）、轻度意识模糊（n = 6）、头痛（n = 4）、步态困难（n = 4）和癫痫发作（n = 3）。诊断的平均时间为电极植入后5.8天，后续CT扫描报告水肿完全/接近完全消退或改善的平均时间为4.7周（范围2 - 10周）。DBS术后1年，UPDRS运动评分显著改善（42.5%，p <.001）；生活质量有所改善，但变化无统计学意义（21.3%，p = 0.197）。1年时认知功能无下降（26.6对26.4，p = 0.567）。这些患者未出现与电极水肿相关的长期并发症。
DBS术后症状性电极水肿是一种罕见的并发症，通常会随时间消退。在我们的系列研究中，该并发症无长期后遗症，临床结局与文献报道相当。
