Lesioning Through a Directional Deep Brain Stimulation Lead in the Subthalamic Nucleus.

CLINICAL VIGNETTE

A 59-year-old woman with a previous subthalamic nucleus deep brain stimulation (DBS) implanted for Parkinson's disease developed a hardware related infection.

CLINICAL DILEMMA

Wound dehiscence and infection developed and necessitated removal of the DBS system. The patient experienced excellent therapeutic benefit from her DBS and expressed concern about device removal.

CLINICAL SOLUTION

The patient was offered the option of a lesioning procedure which could be performed during hardware explantation. An operative procedure was conducted where the intracranial DBS lead was connected to a radiofrequency system in a deliberate effort to create a targeted subthalamotomy through the existing DBS lead. A multilevel lesion was generated using the contacts on the directional DBS lead. Following the lesion the DBS lead and hardware were removed.

GAP IN KNOWLEDGE

Creating a lesion through a DBS lead using radiofrequency ablation is a therapeutic option for patients not interested in later re-implantation or for those with a history of multiple DBS related infections. Lesioning through segmented leads introduces more complexity into the procedure.