Johnson Coplen, Miller Garret, Shah Shivam, Stevens Christopher, Thomas Nicholas, Toms Jamie, Arevalo Octavio
Louisiana State University Health Sciences Center Shreveport, Shreveport, USA.
Neuroradiology. 2025 Apr 8. doi: 10.1007/s00234-025-03607-z.
Postoperative peri-lead edema (PLE) is an increasingly recognized complication of deep brain stimulation (DBS), a therapeutic intervention commonly used for neurological conditions such as Parkinson's disease (PD), essential tremor (ET), intractable focal epilepsy, and dystonia. In this study, we conducted a retrospective chart review to evaluate the incidence of PLE and explore potential clinical and demographic risk factors.
A single physician performed DBS electrode placements. To check for complications, postoperative computed tomography (CT) scans were conducted on the day of surgery and approximately 12-15 days afterward. Data on age, gender, complications, edema size, electrode laterality, lead target, lead brand, indication, and use of robotic assistance versus Starfix were collected and analyzed statistically.
133 leads were implanted in 63 patients, with peri-lead edema (PLE) observed in 65 electrodes (48.87%). Minor postoperative complications, such as subarachnoid hemorrhage (SAH) and subdural hematoma (SDH), were noted in some patients. A few cases of severe PLE were recorded, with the most significant volume of edema reaching 85.11 cm³. No statistically significant differences were found between PLE-positive and PLE-negative patients based on age, sex, lead target, indication, or robotic assistance versus Starfix. However, the use of Boston Scientific electrodes was significantly associated with PLE, with a p-value of 0.047. A logistic regression model (p = 0.013, R² = 0.219) correctly classified 63.2% of cases, with no significant predictors of PLE, but imaging complications (p = 0.057) and electrode brand (p = 0.086) approached significance, with Boston Scientific electrodes linked to higher PLE risk compared to Abbott electrodes (p = 0.027, OR = 3.729).
PLE appears more prevalent than previously reported and generally presents with delayed onset post-surgery. This retrospective analysis identified the use of Boston Scientific electrodes as a potential risk factor for PLE. Further research, particularly more extensive studies, is necessary to clarify the underlying mechanisms of PLE, improve prevention strategies, and enhance our understanding of this complication.
术后电极周围水肿（PLE）是深部脑刺激（DBS）一种越来越被认识到的并发症，DBS是一种常用于治疗帕金森病（PD）、特发性震颤（ET）、顽固性局灶性癫痫和肌张力障碍等神经疾病的治疗干预手段。在本研究中，我们进行了一项回顾性病历审查，以评估PLE的发生率，并探索潜在的临床和人口统计学风险因素。
由一名医生进行DBS电极植入。为检查并发症，在手术当天及术后约12 - 15天进行术后计算机断层扫描（CT）。收集年龄、性别、并发症、水肿大小、电极侧别、电极靶点、电极品牌、适应症以及机器人辅助与Starfix使用情况等数据，并进行统计学分析。
63例患者共植入133根电极，65根电极（48.87%）观察到电极周围水肿（PLE）。部分患者出现少量术后并发症，如蛛网膜下腔出血（SAH）和硬膜下血肿（SDH）。记录到几例严重PLE病例，最大水肿体积达85.11 cm³。基于年龄、性别、电极靶点、适应症或机器人辅助与Starfix，PLE阳性和PLE阴性患者之间未发现统计学显著差异。然而，使用波士顿科学公司的电极与PLE显著相关，p值为0.047。一个逻辑回归模型（p = 0.013，R² = 0.219）正确分类了63.2%的病例，没有PLE的显著预测因素，但影像并发症（p = 0.057）和电极品牌（p = 0.086）接近显著水平，与雅培电极相比，波士顿科学公司的电极与更高的PLE风险相关（p = 0.027，OR = 3.729）。
PLE似乎比先前报道的更普遍，且通常在术后延迟出现。这项回顾性分析确定使用波士顿科学公司的电极是PLE的一个潜在风险因素。需要进一步研究，特别是更广泛的研究，以阐明PLE的潜在机制，改进预防策略，并增进我们对这种并发症的理解。
