Open AccessCerebral Venous Infarction: A Potentially Avoidable Complication of Deep Brain Stimulation Surgery
Author(s) -
Morishita Takashi,
Okun Michael S.,
Burdick Adam,
Jacobson Charles E,
Foote Kelly D.
Publication year - 2013
Publication title -
neuromodulation: technology at the neural interface
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.296
H-Index - 60
eISSN - 1525-1403
pISSN - 1094-7159
DOI - 10.1111/ner.12052
Subject(s) - medicine , subthalamic nucleus , deep brain stimulation , magnetic resonance imaging , complication , surgery , infarction , stroke (engine) , radiology , cerebral infarction , cerebral veins , cardiology , ischemia , disease , parkinson's disease , myocardial infarction , engineering , mechanical engineering
Object Despite numerous reports on the morbidity and mortality of deep brain stimulation ( DBS ), cerebral venous infarction has rarely been reported. We present four cases of venous infarct secondary to DBS surgery. Methods The diagnosis of venous infarction was based on 1) delayed onset of new neurologic deficits on postoperative day 1 or 2; 2) significant edema surrounding the superficial aspect of the implanted lead, with or without subcortical hemorrhage on CT scan. Results Four cases (0.8% per lead, 1.3% per patient) of symptomatic cerebral venous infarction were identified out of 500 DBS lead implantation procedures between J uly 2002 and A ugust 2009. All four patients had P arkinson's disease. Their DBS leads were implanted in the subthalamic nucleus ( n = 2), and the globus pallidus internus ( n = 2). Retrospective review of the targeting confirmed that the planned trajectory passed within 3 mm of a cortical vein in two cases for which contrast‐enhanced preoperative magnetic resonance ( MR ) imaging was available. In the other two cases, contrasted targeting images were not obtained preoperatively. Conclusion Cerebral venous infarction is a potentially avoidable, but serious complication. To minimize its incidence, we propose the use of high‐resolution, contrast‐enhanced, T1 ‐weighted MR images to delineate cerebral venous anatomy, along with careful stereotactic planning of the lead trajectory to avoid injury to venous structures.