Case report of hyperacute edema and cavitation following deep brain stimulation lead implantation

Background: Postoperative cerebral edema around a deep brain stimulation (DBS) electrode is an uncommonly reported complication of DBS surgery. The etiology of this remains unknown, and the presentation is highly variable; however, the patients generally report a good outcome. Case Description: Here, we report an unusual presentation of postoperative edema in a 66-year-old female who has bilateral dentatorubrothalamic tract (specifically, the ventral intermediate nucleus) DBS for a mixed type tremor disorder. Initial postoperative computed tomography (CT) was unremarkable and the patient was admitted for observation. She declined later on postoperative day (POD) 1 and became lethargic. Stat head CT scan performed revealed marked left-sided peri-lead edema extending into the centrum semiovale with cystic cavitation, and trace right-sided edema. On POD 2, the patient was alert, but with global aphasia, right-sided neglect, and a plegic right upper extremity. Corticosteroids were started and a complete infectious workup was unremarkable. She was intubated and ultimately required a tracheostomy and percutaneous gastrostomy tube. She returned to the clinic 3 months postoperatively completely recovered and ready for battery implantation. Conclusion: While this is an unusual presentation of cerebral edema following DBS placement, ultimately, the outcome was good similar to other reported cases. Supportive care and corticosteroids remain the treatment of choice for this phenomenon.

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Deep Brain Stimulation for Tremor: Update on Long-Term Outcomes, Target Considerations and Future Directions

Journal of Clinical Medicine ◽

10.3390/jcm10163468 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3468

Author(s):

Naomi I. Kremer ◽

Rik W. J. Pauwels ◽

Nicolò G. Pozzi ◽

Florian Lange ◽

Jonas Roothans ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Focused Ultrasound ◽

Neurosurgical Procedures ◽

Drug Resistant ◽

Long Term Outcomes ◽

Future Directions ◽

Ventral Intermediate Nucleus ◽

Deep Brain

Deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus is one of the main advanced neurosurgical treatments for drug-resistant tremor. However, not every patient may be eligible for this procedure. Nowadays, various other functional neurosurgical procedures are available. In particular cases, radiofrequency thalamotomy, focused ultrasound and radiosurgery are proven alternatives to DBS. Besides, other DBS targets, such as the posterior subthalamic area (PSA) or the dentato-rubro-thalamic tract (DRT), may be appraised as well. In this review, the clinical characteristics and pathophysiology of tremor syndromes, as well as long-term outcomes of DBS in different targets, will be summarized. The effectiveness and safety of lesioning procedures will be discussed, and an evidence-based clinical treatment approach for patients with drug-resistant tremor will be presented. Lastly, the future directions in the treatment of severe tremor syndromes will be elaborated.

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Deep Brain Stimulation of the Ventral Intermediate Nucleus of the Thalamus for Control of Tremors in Parkinson’s Disease and Essential Tremor

Stereotactic and Functional Neurosurgery ◽

10.1159/000029671 ◽

1999 ◽

Vol 72 (1) ◽

pp. 47-61 ◽

Cited By ~ 51

Author(s):

Krishna Kumar ◽

Michael Kelly ◽

Cory Toth

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Essential Tremor ◽

Brain Stimulation ◽

Intermediate Nucleus ◽

Ventral Intermediate Nucleus ◽

Deep Brain ◽

Stimulation Of

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Comparing deep brain stimulation in the ventral intermediate nucleus versus the posterior subthalamic area in essential tremor patients

Surgical Neurology International ◽

10.4103/sni.sni_234_18 ◽

2018 ◽

Vol 9 (1) ◽

pp. 244 ◽

Cited By ~ 1

Author(s):

PieterL Kubben ◽

Aurélie Degeneffe ◽

MarkL Kuijf ◽

Linda Ackermans ◽

Yasin Temel

Keyword(s):

Deep Brain Stimulation ◽

Essential Tremor ◽

Brain Stimulation ◽

Intermediate Nucleus ◽

Ventral Intermediate Nucleus ◽

Deep Brain

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Evaluating and Optimizing Dentato-Rubro-Thalamic-Tract Deterministic Tractography in Deep Brain Stimulation for Essential Tremor

Operative Neurosurgery ◽

10.1093/ons/opab324 ◽

2021 ◽

Author(s):

Maarten Bot ◽

Anne-Fleur van Rootselaari ◽

Vincent Odekerken ◽

Joke Dijk ◽

Rob M A de Bie ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Essential Tremor ◽

Brain Stimulation ◽

Red Nucleus ◽

Brain Regions ◽

Superior Cerebellar Peduncle ◽

Beneficial Effects ◽

Ventral Intermediate Nucleus ◽

Cerebellar Peduncle ◽

Deep Brain

Abstract BACKGROUND Dentato-rubro-thalamic tract (DRT) deep brain stimulation (DBS) suppresses tremor in essential tremor (ET) patients. However, DRT depiction through tractography can vary depending on the included brain regions. Moreover, it is unclear which section of the DRT is optimal for DBS. OBJECTIVE To evaluate deterministic DRT tractography and tremor control in DBS for ET. METHODS After DBS surgery, DRT tractography was conducted in 37 trajectories (20 ET patients). Per trajectory, 5 different DRT depictions with various regions of interest (ROI) were constructed. Comparison resulted in a DRT depiction with highest correspondence to intraoperative tremor control. This DRT depiction was subsequently used for evaluation of short-term postoperative adverse and beneficial effects. RESULTS Postoperative optimized DRT tractography employing the ROI motor cortex, posterior subthalamic area (PSA), and ipsilateral superior cerebellar peduncle and dentate nucleus best corresponded with intraoperative trajectories (92%) and active DBS contacts (93%) showing optimal tremor control. DRT tractography employing a red nucleus or ventral intermediate nucleus of the thalamus (VIM) ROI often resulted in a more medial course. Optimal stimulation was located in the section between VIM and PSA. CONCLUSION This optimized deterministic DRT tractography strongly correlates with optimal tremor control. This technique is readily implementable for prospective evaluation in DBS target planning for ET.

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Deep-Brain Stimulation for Essential Tremor and Other Tremor Syndromes: A Narrative Review of Current Targets and Clinical Outcomes

Brain Sciences ◽

10.3390/brainsci10120925 ◽

2020 ◽

Vol 10 (12) ◽

pp. 925

Author(s):

Christian Iorio-Morin ◽

Anton Fomenko ◽

Suneil K. Kalia

Keyword(s):

Multiple Sclerosis ◽

Deep Brain Stimulation ◽

Essential Tremor ◽

Brain Stimulation ◽

Zona Incerta ◽

Future Directions ◽

Ventral Intermediate Nucleus ◽

Prevalent Symptom ◽

Multiple Conditions ◽

Deep Brain

Tremor is a prevalent symptom associated with multiple conditions, including essential tremor (ET), Parkinson’s disease (PD), multiple sclerosis (MS), stroke and trauma. The surgical management of tremor evolved from stereotactic lesions to deep-brain stimulation (DBS), which allowed safe and reversible interference with specific neural networks. This paper reviews the current literature on DBS for tremor, starting with a detailed discussion of current tremor targets (ventral intermediate nucleus of the thalamus (Vim), prelemniscal radiations (Raprl), caudal zona incerta (Zi), thalamus (Vo) and subthalamic nucleus (STN)) and continuing with a discussion of results obtained when performing DBS in the various aforementioned tremor syndromes. Future directions for DBS research are then briefly discussed.

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Deep brain stimulation of the ventral intermediate nucleus in patients with essential tremor: Stimulation below intercommissural line is more efficient but equally effective as stimulation above

Experimental Neurology ◽

10.1016/j.expneurol.2011.04.005 ◽

2011 ◽

Vol 230 (1) ◽

pp. 131-137 ◽

Cited By ~ 51

Author(s):

Michael T. Barbe ◽

Lena Liebhart ◽

Matthias Runge ◽

Janina Deyng ◽

Esther Florin ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Essential Tremor ◽

Brain Stimulation ◽

Intermediate Nucleus ◽

Ventral Intermediate Nucleus ◽

Deep Brain ◽

Stimulation Of

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Longitudinal follow-up with VIM thalamic deep brain stimulation for dystonic or essential tremor

Neurology ◽

10.1212/wnl.0000000000008875 ◽

2020 ◽

Vol 94 (10) ◽

pp. e1073-e1084 ◽

Cited By ~ 6

Author(s):

Takashi Tsuboi ◽

Zakia Jabarkheel ◽

Pamela R. Zeilman ◽

Matthew J. Barabas ◽

Kelly D. Foote ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Essential Tremor ◽

Brain Stimulation ◽

Rating Scale ◽

Statistical Significance ◽

Ventral Intermediate Nucleus ◽

Deep Brain

ObjectiveTo assess longitudinal tremor outcomes with ventral intermediate nucleus deep brain stimulation (VIM DBS) in patients with dystonic tremor (DT) and to compare with DBS outcomes in essential tremor (ET).MethodsWe retrospectively investigated VIM DBS outcomes for 163 patients followed at our center diagnosed with either DT or ET. The Fahn-Tolosa-Marin tremor rating scale (TRS) was used to assess change in tremor and activities of daily living (ADL) at 6 months, 1 year, 2–3 years, 4–5 years, and ≥6 years after surgery.ResultsTwenty-six patients with DT and 97 patients with ET were analyzed. Compared to preoperative baseline, there were significant improvements in TRS motor up to 4–5 years (52.2%; p = 0.032) but this did not reach statistical significance at ≥6 years (46.0%, p = 0.063) in DT, which was comparable to the outcomes in ET. While the improvements in the upper extremity tremor, head tremor, and axial tremor were also comparable between DT and ET throughout the follow-up, the ADL improvements in DT were lost at 2–3 years follow-up.ConclusionOverall, tremor control with VIM DBS in DT and ET was comparable and remained sustained at long term likely related to intervention at the final common node in the pathologic tremor network. However, the long-term ADL improvements in DT were not sustained, possibly due to inadequate control of concomitant dystonia symptoms. These findings from a large cohort of DT indicate that VIM targeting is reasonable if the tremor is considerably more disabling than the dystonic features.Classification of evidenceThis study provides Class IV evidence that VIM DBS improves tremor in patients with DT or ET.

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