Unveiling patterns of peri-lead edema after deep brain stimulation: a retrospective review of clinical and demographic factors.

OBJECTIVE

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.