Huang Hui, Hu Shangwei, Xie Liyuan, Xiao Bing, Huang Hongming, Guo Ming, Zheng Suyue, Lu Mingwei
Department of Neurosurgery, Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China (mainland)
Med Sci Rev 2018; 5:14-18
Deep brain stimulation (DBS) in the subthalamic nucleus is considered to be a well-established treatment for patients with Parkinson’s disease who have severe motor dysfunctions. Bleeding is a severe complication of DBS surgery, and it has been reported to occur mainly around the time of the implantation of electrodes. To the best of our knowledge, bleeding caused by a focal infarction and underlying vascular disease as a complication of DBS surgery has never been described. We report a case of intracerebral hemorrhage originating from infarcted areas after DBS surgery. Magnetic resonance (MR) imaging before the operation did not show any abnormalities in the patient and only showed a small infarction zone. Computed tomography (CT) imaging performed immediately after the operation showed an intracranial hematoma near the trajectory of the DBS lead. The patient did not recover from the coma after the DBS surgery. As an intraoperative finding, we noticed the presence of an infarction zone in the thalamus. We noted that the microelectrode recording (MER) silence areas indicated focal ischemia during the surgery. Although the incidence is low, intraoperative bleeding during DBS surgery can occur and measures should be taken to prevent its occurrence as much as possible. Careful detection of a focal infarct and an assessment of vessels using MR angiography might be necessary before surgery. Moreover, paying close attention to the reduction trials of MER in an infarct zone during surgery might be important.
Keywords: cerebral infarction, Deep Brain Stimulation, Intracranial Hemorrhages, Intraoperative Complications