RESEARCHERS have discovered that peri-electrode oedema after deep brain stimulation (DBS) for Parkinson’s Disease occurs in 40% of cases, and asleep surgery is the only independent predictive factor for oedema onset.
Peri-electrode oedema is a known postoperative occurrence following DBS surgery for Parkinson’s Disease, with studies reporting incidences as high as 100%. However, the clinical significance of this oedema is unclear, and risk factors are not well-established. Therefore, the objective of this study was to determine the incidence, clinical impact, and predictive factors associated with peri-electrode oedema in PD patients undergoing DBS.
A retrospective review was conducted on 119 patients who underwent frameless stereotactic DBS for PD between 2012 and 2022 at a single institution. Of these, 90 patients met the inclusion criteria. A mixed targeting approach was used, with 64.7% undergoing awake surgery, often using microelectrode recording (MER). The subthalamic nucleus (STN) was the target in 91.2% of cases. Postoperative imaging revealed oedema in 40% of patients, typically appearing two days after surgery. In 88.9% of cases, the oedema was restricted to subcortical white matter, and only one patient (1.1%) exhibited symptomatic oedema. Statistical analysis showed that asleep surgery was the only independent predictor of oedema (p = 0.0451), while factors such as patient age, use of directional electrodes, and timing of postoperative CT scans did not significantly influence oedema onset.
This study confirms the low incidence of symptomatic peri-electrode oedema following DBS for Parkinson’s Disease, with asleep surgery identified as the primary risk factor for its development. In clinical practice, awake DBS using MER should be preferred to reduce the risk of postoperative oedema. Future studies should investigate other potential predictors of oedema and assess long-term outcomes in patients with radiologically detected but asymptomatic oedema to better inform surgical decision-making.
Katrina Thornber, EMJ
Reference
Izzo A et al. Risk factors and significance of post-operative edema in Parkinson Disease patients submitted to deep brain stimulation. A ten-year case series. Neurol Sci. 2024;DOI:10.1007/s10072-024-07774-4.
