Elberson Brooke, Scott Hayden, Dhall Rohit, Petersen Erika
Departments of1Neurosurgery.
2Surgery, and.
J Neurosurg Case Lessons. 2023 Sep 18;6(12). doi: 10.3171/CASE23349.
Deep brain stimulation (DBS) is a well-established neurosurgical intervention for a growing number of neurological and psychiatric diseases. Patients who are affected by Parkinson's disease may benefit from DBS of either the subthalamic nucleus or the globus pallidus internus. Patients who undergo DBS often notice a significant reduction in their clinical symptoms; however, the procedure is not without risks. Multicenter studies have reported postoperative complications such as hardware infection, intracranial hemorrhage, and perielectrode edema.
The authors report a case of a perielectrode cyst managed conservatively. Tracking the impedance trend was a novel approach to monitor for changes within the cyst and to herald a clinical change in the patient. Perielectrode cystic formation can be a transient process that resolves spontaneously or with conservative, nonoperative management, and all diagnostic information is valuable in making clinical decisions.
Impedance values have provided an appropriate estimation of this patient's clinical picture. The authors suggest treatment of edema and a cyst after DBS lead implantation through conservative management and observation, avoiding the removal of hardware if a patient's clinical picture is either stable or improving and forgoing additional clinical imaging if the impedance values are trending in an appropriate direction.
对于越来越多的神经和精神疾病，脑深部电刺激（DBS）是一种成熟的神经外科干预手段。帕金森病患者可能从丘脑底核或内侧苍白球的DBS中获益。接受DBS的患者常常注意到其临床症状显著减轻；然而，该手术并非没有风险。多中心研究报告了术后并发症，如硬件感染、颅内出血和电极周围水肿。
作者报告了一例经保守治疗的电极周围囊肿病例。追踪阻抗趋势是监测囊肿内变化并预示患者临床变化的一种新方法。电极周围囊性形成可能是一个短暂的过程，可自发或通过保守的非手术治疗解决，所有诊断信息对于做出临床决策都很有价值。
阻抗值对该患者的临床情况提供了恰当的评估。作者建议在DBS电极植入后，通过保守治疗和观察来处理水肿和囊肿，如果患者的临床情况稳定或改善则避免取出硬件，如果阻抗值朝着合适的方向变化则无需进行额外的临床成像检查。
