Izzo Alessandro, Bove Francesco, D'Alessandris Quintino Giorgio, Genovese Danilo, Tufo Tommaso, D'Ercole Manuela, Pennisi Giovanni, Figà Federica, Obersnel Marco, Perotti Valerio, Fuggetta Maria Filomena, Bentivoglio Anna Rita, Calabresi Paolo, Olivi Alessandro, Piano Carla, Montano Nicola
Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Department of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Neurol Sci. 2025 Feb;46(2):761-768. doi: 10.1007/s10072-024-07774-4. Epub 2024 Sep 19.
Peri-electrode edema after deep brain stimulation (DBS) surgery for Parkinson Disease (PD) has been reported in up to 100% of cases. The clinical significance of this finding is unclear, with most papers suggesting a benign course. The risk factors are also poorly defined. We aimed at defining the incidence rate, the clinical significance and the predictive factors of peri-electrode edema in patients undergoing DBS for PD.
We reviewed data of 119 patients treated with frameless stereotactic DBS for PD between 2012 and 2022 at our Institution. A mixed-technique targeting was adopted. Awake surgery was used in 64.7% cases; in most cases, microelectrode recording (MER) was adopted. The target was the subthalamic nucleus (STN) in 91.2% cases.
Ninety patients were included. Postoperative edema related to lead placement was noticed in 40% patients after a median time of 2 days since surgery; in 88.9% of these cases, it was limited to subcortical white matter. Symptomatic edema was registered only in one case (1.1%), confirming previous reports on the benign clinical course. The only independent predictive factor for edema onset was asleep surgery (p = 0.0451). Notably, the use of directional electrodes was not associated with an increased risk of edema at multivariable analysis. Clinical parameters including age, and timing of CT scanning, did not affect edema onset.
We confirmed the very low rate of symptomatic edema in DBS for PD. When feasible, awake DBS using MER is the ideal technique to reduce the risk of radiologic postoperative edema.
据报道，帕金森病（PD）患者在接受脑深部电刺激（DBS）手术后，电极周围水肿的发生率高达100%。这一发现的临床意义尚不清楚，大多数论文表明其病程呈良性。其危险因素也未明确界定。我们旨在确定接受PD-DBS治疗的患者电极周围水肿的发生率、临床意义和预测因素。
我们回顾了2012年至2022年在我们机构接受无框架立体定向DBS治疗的119例PD患者的数据。采用了混合技术靶点定位。64.7%的病例采用了清醒手术；在大多数情况下，采用了微电极记录（MER）。91.2%的病例靶点为丘脑底核（STN）。
纳入90例患者。术后中位2天，40%的患者出现与电极植入相关的水肿；其中88.9%的病例仅限于皮质下白质。仅1例（1.1%）出现症状性水肿，证实了先前关于良性临床病程的报道。水肿发生的唯一独立预测因素是睡眠中手术（p = 0.0451）。值得注意的是，在多变量分析中，使用定向电极与水肿风险增加无关。包括年龄和CT扫描时间在内的临床参数不影响水肿的发生。
我们证实PD-DBS治疗中症状性水肿的发生率极低。在可行的情况下，使用MER的清醒DBS是降低术后影像学水肿风险的理想技术。
