Lebrón Sánchez Yeimy Margarita, Torres Viviana, Carreras Angel, Jimenez Marrero Alejandro A, Bleubar Ozoria Ruben Dario, Rivera Lianca, Pérez-Fernández Ambar
Parkinson's Disease and Movement Disorders Unit, Neurofunctional Group, Santo Domingo, DOM.
Institute of Human Anatomy, Autonomous University of Santo Domingo (UASD), Santo Domingo, DOM.
Cureus. 2025 Jan 15;17(1):e77506. doi: 10.7759/cureus.77506. eCollection 2025 Jan.
Deep brain stimulation (DBS) has become a critical intervention for managing advanced Parkinson's disease (PD), particularly for patients whose symptoms are no longer controlled by medication. This report details the case of a 61-year-old male with PD who experienced electrode displacement due to pneumocephalus following DBS surgery targeting the subthalamic nucleus (STN). Initial imaging revealed a significant subdural air volume causing electrode displacement. However, one month later, spontaneous pneumocephalus resorption led to the functional repositioning of the electrodes, restoring proper function and negating the need for reoperation. The accompanying systematic review analyzed 24 studies, involving 1,439 patients across 12 countries, to assess the occurrence and management in this specific scenario. Findings showed electrode displacement occurred in 75% of cases, but spontaneous repositioning happened only in 12.5%, typically with air volumes below 10 cm³. Larger volumes often required surgical intervention, though definitive thresholds for action remain unclear. The review highlights inconsistencies in managing this complication, emphasizing the need for clearer protocols to improve outcomes. This work underscores the rarity of spontaneous electrode realignment and the importance of careful evaluation of pneumocephalus volume and patient symptoms. It advocates for evidence-based management strategies to balance clinical intervention with the potential for natural resolution, aiming to enhance DBS efficacy and patient quality of life. Further research is necessary to establish standardized guidelines for addressing this complication.
深部脑刺激（DBS）已成为治疗晚期帕金森病（PD）的关键干预措施，特别是对于症状不再受药物控制的患者。本报告详细介绍了一名61岁的帕金森病男性患者的病例，该患者在针对丘脑底核（STN）进行DBS手术后因气颅导致电极移位。初始影像学检查显示硬膜下有大量气体，导致电极移位。然而，一个月后，气颅自发吸收，使电极功能重新定位，恢复了正常功能，无需再次手术。随附的系统评价分析了24项研究，涉及12个国家的1439名患者，以评估这种特定情况下的发生率和处理方法。研究结果显示，75%的病例发生了电极移位，但只有12.5%的病例出现了自发重新定位，通常气体量低于10立方厘米。较大的气体量通常需要手术干预，不过明确的行动阈值仍不清楚。该评价强调了在处理这种并发症方面存在的不一致性，强调需要更明确的方案来改善治疗结果。这项工作强调了自发电极重新排列的罕见性以及仔细评估气颅体积和患者症状的重要性。它提倡采用循证管理策略，以平衡临床干预与自然缓解的可能性，旨在提高DBS的疗效和患者的生活质量。有必要进行进一步的研究，以建立处理这种并发症的标准化指南。
